Medical Requirement 5th Edition Amendment 02

CIVIL AVIATION AUTHORITY OF NEPAL
MEDICAL REQUIREMENTS
FIFTH EDITION 2020

5th Edition
MEDICAL REQUIREMENTS 19 October 2020
Adoption of the Standards of the Annexes to the Chicago Convention of ICAO under Rule 81
and approved for publication by the Director General, Civil Aviation Authority of Nepal under
Rule 82 of the Civil Aviation Rules, 2058 BS.(2002 CE).
First Edition 2002

Second Edition 2004
Third Edition 2009
Fourth Edition 2016
Fifth Edition 2020
This manual is available at:

Licensing and Examination Division, Flight Safety Standards
Department Civil Aviation Authority of Nepal
Sinamangal, Kathmandu
4111042, 4111075
Fax: 97714111198
REGULATORY REFERENCES
These Medical Requirements are to be read in conjunction with other related regulatory
documents such as:
1.1. Civil Aviation Regulations 2002.
1.2. Flight Operations Requirements (FOR) Aeroplane, General Aviation and Helicopters
1.3. Nepalese Civil Aviation Airworthiness Requirements (NCAR)
1.4. Aeronautical Information Publications Nepal (AIP)
1.5. Personnel Licensing Requirements (PeLR)
1.6. Personnel Licensing Manual (PLM)
1.7. Dangerous Goods Handling Requirements (DGHR)
1.8. Medical Requirements
1.9. Aviation Enforcement Procedure Manual
1.10. CAAN DCP manual
1.11. ATO Manual
1.12. NFSR (Nepalese Flying School Requirements)
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Intentionally left blank

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RECORD OF AMENDMENTS
Number Date Entered by
01 April 01, 2021 Januka Khanal
02 March 17, 2023 Januka Khanal
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LIST OF EFFECTIVE PAGES
CHAPTER PAGE REVISION NUMBER DATE
CH-1 1-12 01 April 01, 2021
CH-1 1-10, 1-11 02 March 17, 2023
CH-2 2-27 02 March 17, 2023
CH-3 3-15, 3-16 02 March 17, 2023
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APPLICABILITY
These requirements are related to the provisions of Medical Examination and Assessment and
Medical Standards for Licensing Requirements of Flight Crew and Air Traffic Controllers, and
outlines guidelines for reviewing medical fitness in different medical/ailment conditions. These
Medical Requirements will be applicable from the date of approval by the Director General.
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INTRODUCTION
One of the functions of Civil Aviation Authority of Nepal is to issue licences through the
Licensing and Examination Division of Flight Safety Standards Department to Flight Crew and
Air Traffic Controllers. Besides knowledge and skill, the applicant must possess adequate levels
of health, both physical and mental, and correctly functioning senses to safely perform the task.
Hence, 'Medical Examination and Assessment' of the applicant forms an integral component and
a regulatory requirement, before a licence is issued, whether it be an initial or a renewal. An
applicant shall be free of any condition or disease that may jeopardize the safety of a flight while
performing their duties.
The Medical Requirements have been prepared in cooperation with senior COSCAP aviation
medicine experts as per the guideline of ICAO Annex-1 and Doc 8984. Consideration of
ailments prevalent in Nepal has been made and the Requirements designed accordingly. They
have been prepared for the Civil Aviation Medical Examiner, Licensing and Examination
Division and Civil Aviation Authority of Nepal to provide guidelines for medical information
and standards, Policies and Procedure in order to provide licence requirements of Flight Crew
and Air Traffic Controllers and assess their fitness in the presence or absence of medical
conditions.
Medical Requirements consists of 4 parts:
Part 0 : Document Control

Part 1 : Requirements for Medical Examination and Assessment
Part 2 : Medical Standards of Licensing Requirements
Part 3 : Guidelines on Medical Conditions.
They are in conformity with ICAO Standards and Recommended Practices contained in Annex 1
to the Convention on International Civil Aviation and are duly adopted by Civil Aviation
Authority of Nepal. These Requirements are also incorporated into the Flight Operation
Requirements and Personnel Licensing Requirements issued by Civil Aviation Authority of
Nepal. In the preparation of these Requirements, Manual of Civil Aviation Medicine ICAO, Doc
8984-AN/895, and other Regulations and Standards practiced by leading aviation countries have
also been referenced.
As knowledge and techniques are advancing rapidly and more and more experience is achieved,
both in medicine and aviation, these medical requirements may be amended by Director
General, Civil Aviation Authority of Nepal as and when appropriate.
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TABLE OF CONTENTS
Page
FOREWORD i
RECORD OF AMENDMENTS ii
LIST OF EFFECTIVE PAGES iii
APPLICABILITY iv
INTRODUCTION v
TABLE OF CONTENT TOC-1 to TOC-3
DEFINITIONS DEF-1 TO DEF-3
ABBREVIATIONS ABB
PART 0 DOCUMENT CONTROL 0-1 to 0-4
PART 1 GENERAL REQUIREMENT FOR MEDICAL

EXAMINATION AND ASSESSMENT 1-1
1.1 REQUIREMENT OF MEDICAL ASSESSMENT 1-2
1.2 MEDICAL FORMS 1-2
1.3 MEDICAL HISTORY DECLARATION 1-2
1.4 MEDICAL EXAMINATION 1-3
1.5 MEDICAL ASSESSMENT 1-5
1.6 MEDICAL CONFIDENTIALITY 1-6
1.7 MEDICAL FITNESS 1-6
1.8 DECREASE IN MEDICAL FITNESS 1-6
1.9 BORDERLINE MEDICAL FINDING 1-7
1.10 ACCREDITED MEDICAL OPINION 1-7
1.11 MEDICAL FLIGHT TEST 1-7
1.12 FLEXIBILITY CLAUSE 1-7
1.13 MEDICALLY UNFIT OR DEFERRED MEDICAL

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ASSEESSMENT 1-8
1.14 SUSPENSION OF LICENCE ON MEDICAL GROUNDS 1-8
1.15 PROVISION OF APPEAL 1-8
1.16 EXPIRED LICENCE DUE TO MEDICAL REASON 1-8
1.17 VALIDATION OF FOREIGN LICENCE 1-9
1.18 DISPENSATION OF MEDICAL EXAMINATION AND

ASSESSMENT 1-9
1.19 EXCEEDING CUMULATIVE FLIGHT HOURS LIMITATION 1-9
1.20 FEE 1-9
1.21 DESIGNATED MEDICAL EXAMINER 1-9
1.22 SPECIALIST MEDICAL EXAMINER 1-11
1.23 CIVIL AVIATION MEDICAL ASSESSOR 1-12
1.24 MEDICAL ASSESSMENT CLASSES 1-13
1.25 VALIDITY PERIOD OF MEDICAL ASSESSMENT 1-14
1.26 MEDICAL VALIDITY 1-14
1.27 AGE 1-15
1.28 HEIGHT 1-16
1.29 WEIGHT 1-16
PART 2 MEDICAL STANDARDS OF LICENSING

REQUIREMENTS 2-1
2.1. MEDICAL ASSESSMENT- GENERAL 2-2
2.2 REQUIREMENTS FOR MEDICAL ASSESSMENT 2-3
PART 3 GUIDELINES ON MEDICAL CONDITIONS 3-1

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3.1 GENERAL 3-2
3.2 NEURO-PSYCHIATRIC CONDITIONS 3-4
3.3 NEUROLOGICAL CONDITIONS 3-4
3.4 CARDIO-VASCULAR CONDITIONS 3-7
3.5 RESPIRATORY CONDITIONS 3-15
3.6 GASTRO-INTESTINAL CONDITIONS 3-16
3.7 GENITO-URINARY CONDITIONS 3-17
3.8 METABOLIC, NUTRITIONAL AND ENDOCRINAL

CONDITIONS 3-18
3.9 MUSCULO-SKELETAL CONDITIONS 3-21
3.10 EAR, NOSE & THROAT CONDITIONS 3-22
3.11 EYE CONDITIONS 3-23
ATTACHMENTS
MED FORM A-1/6: Application and Statement Form,

MED FORM A-2/6: Medical Examination Form,
MED FORM A-3/6: Medical Examination Form for Ear, Nose & Throat Examination
MED FORM A-4/6: Medical Examination Form for Eye, Visual Acuity and Colour Perception.
MED FORM A-5/6: Medical Assessment Form.
MED FORM A-6/6: Medical Certificate.

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DEFINITIONS
In the Medical Requirements, the following terms have meanings as defined below:
Accredited medical conclusion: The conclusion reached by one or more medical experts
acceptable to the Licensing Authority for the purposes of the case concerned, in consultation
with flight operations or other experts as necessary.
Aeroplane: A power-driven heavier-than-air aircraft deriving its lift in flight chiefly from
aerodynamic reactions on surfaces, which remain fixed under given conditions of flight.
Aircraft: Any machine that can derive support in the atmosphere from the reactions of the air
other than the reactions of the air against the earth's surface.
Balloon: A non-power driven, lighter-than-air aircraft.
Note 1: — Medical assessors evaluate medical reports submitted to the CAAN by medical
examiners.
Note 2: — Medical assessors are expected to maintain the currency of their professional
knowledge.
Civil Aviation Medical Assessor: A physician, appointed by the Licensing Authority, qualified
and experienced in the practice of aviation medicine and competent in evaluating and assessing
medical conditions of flight safety significance.
Co-pilot: A licenced pilot serving in any piloting capacity other than as pilot-in-command but
excluding a pilot who is on board the aircraft for the sole purpose of receiving flight instruction.
Crew member: A person assigned by an operator to duty on an aircraft during flight time.
Decrease in Medical Fitness: It is a state or period when there is diminished medical fitness that
may be attributable to illness, injuries, drugs or physical, physiological or mental stresses or
finding outside the prescribed normal ranges, which lasts usually for certain period of time and is
of temporary nature.
Designated Medical Examiner: A physician with training in aviation medicine and practical
knowledge and experience of the aviation environment who is designated by the Licensing
Authority to conduct medical examinations of fitness of applicants for licences or ratings for
which medical requirements are prescribed.
Flight Crew: A licenced crew charged with duties essential to the operation of an aircraft during
flight duty period.
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Flight crew member: A licenced crew member charged with duties essential to the operation of
an aircraft during flight time.
Flight duty period: The total time from the moment a flight crew member commences duty,
immediately subsequent to a rest period and prior to making a flight or a series of flights, to the
moment he is relieved of all duties having completed such flight or series of flights.
Flight Time: The total time from the moment an aircraft first moves for the purpose of taking
off until the moment it comes to rest at the end of flight.
Flight time — aeroplanes: The total time from the moment an aeroplane first moves for the
purpose of taking off until the moment it finally comes to rest at the end of the flight.
Flight time — helicopters: The total time from the moment a helicopter‘s rotor blades start
turning until the moment the helicopter finally comes to rest at the end of the flight, and the rotor
blades are stopped.
General aviation: All civil aviation operations other than scheduled air services and non-
scheduled air transport operations for remuneration or hire.
Glider: A non-power driven, heavier-than-air aircraft, deriving its lift in flight chiefly from
aerodynamic reaction on surfaces which remain fixed under given conditions of flight.
Helicopter: A heavier-than-air aircraft supported in flight chiefly by the reactions of the air on
one or more power-driven rotors on substantially vertical axes.
Human Performance: Human capabilities and limitations which have an impact on the safety
and efficiency of aeronautical operations.
Licensing and Examination Division (LED): The unit responsible for issuing and renewing the
licence to flight crew and air traffic controllers in accordance with the applicable requirement.
Licensing Authority: The Director General of Civil Aviation Authority of Nepal is responsible
for the licensing of personnel.
Likely: In the context of the medical provisions, likely means with a probability of occurring
that is unacceptable to the Medical Assessor.
Medical Assessment: The evidence issued by a Contracting State that the licence holder meets
specific requirements of medical fitness.
Medical Condition: Medical finding, physical or numerical, outside the normal range or
standards of medical requirements.

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Medical Flight Test: Actual flight test done to help assess the applicant's ability to perform
under normal as well as adverse flight conditions if there is suspicion or overt manifestation of
decreased physical ability or functional limitation.
Pilot-in-command: The pilot responsible for the operation and safety of the aircraft during
flight.
Psychoactive Substances: Alcohol, opioids, cannabinoids, sedatives and hypnotics, cocaine,

other psycho-stimulants, hallucinogens, and volatile solvents, whereas coffee and tobacco are
excluded.
Problematic use of substances: The use of one or more psychoactive substances by aviation
personnel in a way that;
a) constitutes a direct hazard to the user or endangers the lives, health or welfare of others;
and/or
b) causes or worsens an occupational, social, mental or physical problem or disorder.
Rated air traffic controller: An air traffic controller holding a licence and valid ratings
appropriate to the privileges exercised by him.
Rating: An authorisation entered on or associated with a licence and forming part thereof,
stating special conditions, privileges or limitations pertaining to such licence.
Rest period: Any period of time on the ground during which a flight crew member is relieved of
all duties by the operator.
Safety-sensitive personnel: Persons who might endanger aviation safety if they perform their
duties and functions improperly. This definition includes, but is not limited to, flight crew, cabin
crew, aircraft maintenance personnel and air traffic controllers.
Significant: In the context of the medical provisions in ICAO Annex 1 to the Convention on
International Aviation, Chapter 6, significant means to a degree or of a nature that is likely to
jeopardize flight safety.
Specialist Medical Examiner: Specialists from various fields of medicine designated by the
Licensing Authority to conduct medical examinations of fitness of applicants for licences or
ratings in their respective fields for which medical requirements are prescribed.

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ABBREVIATIONS
ATC Air Traffic Controller
ATPL Airline Transport Pilot Licence
CAAN Civil Aviation Authority of Nepal
CAMA Civil Aviation Medical Assessor
CAR Civil Aviation Regulations – 2058 (2002)
COSCAP Co-operative Development of Operational Safety and Continuing

Airworthiness under ICAO Technical Co-operation Programme
CPL Commercial Pilot Licence
DG Director General
DME Designated Medical Examiner
Dy. DG Deputy Director General
FOD Flight Operation Division
FOR Flight Operation Requirements
ICAO International Civil Aviation Organization
LED Licensing and Examination Division
MPL Multi-crew Pilot Licence
PPL Private Pilot Licence
SME Specialist Medical Examiner
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PART 0
DOCUMENT CONTROL
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0.1. General
Changes to this Requirement may be required as a result of the changes in government policy,
medical advances, Quality Assurance activities or periodic review. To maintain the credibility
and relevancy of the Requirements, it is required to be reviewed and revised to reflect changing
circumstances.
This Requirement is issued under the authority of the Licensing and Examination Division,
CAAN and is distributed according to the Distribution List. This Requirement is to be used only
after it is approved by the Director General of Civil Aviation Authority of Nepal.
0.2. Person Responsible for Amendment and Revision

CAAN Licensing and Examination Division is responsible for the issue, amendment and revision
of this manual in co-ordination with Civil Aviation Medical Assessor and with approval from the
Director General CAAN. The Licensing and Examination Division shall maintain a list of the
issued requirements with current edition, name of the holder, amendment information including
current amendment and distribution list of the holders.
0.3. Amendment Procedure

This requirement is controlled by CAAN Licensing and Examination Division who is
responsible for amending and distributing it to all holders as per the distribution list. Each copy
of a manual should bear a serial number and a list of holders. The requirements shall be reviewed
every three years for necessary amendment. Proposed amendments to the manual should be
submitted to CAMA for approval before forwarding to DG CAAN. Approval from CAAN for
the amendment will be given in written form. On receipt of the approved amendment from
CAAN, the Chief of Licensing and Examination Division is responsible for ensuring the
distribution of revisions to all holders mentioned in the Distribution List. Holders are responsible
for incorporating such revisions. Every amendment or revision is identified by an amendment
number entered at the bottom left hand side of each page. Minor amendments as described in
0.5.1 below shall be notified to DG CAAN but do not require approval from DG CAAN.
0.4. Amendment and Revision incorporation process

After each Manual Revision and Amendment, the Licensing and Examination Division of
CAAN shall prepare a Manual Amendment Checklist. The requirements Holder shall remove
pages and add pages according to the Manual Amendment Checklist. The requirement holder is
then required to advise Licensing and Examination Division that the amendments or revision
have been incorporated and that any changes have been implemented from the date of the
approval.

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0.5. CAAN Approvals of Amendments

The CAAN Licensing and Examination Division is the final authority for proposing any
amendments in respect to these requirements, and for submitting such amendments to the DG,
CAAN.
The contents of all amendments and revisions must be acceptable to, or, where
applicable, approved by the CAAN. The following procedures shall apply.
0.5.1. Minor Amendments to the Requirements
The following are considered as minor changes and may be implemented without approval
from the CAAN:
 Text changes which do not influence the approved procedures.
 Layout changes which do not influence the approved procedures.
Licensing and Examination Division shall submit DG CAAN with intended amendments in
advance of the effective date.
0.5.2. Major Amendments to the Requirements
All changes other than those in Para 0.5.1 above, are considered major amendments and
require prior approval from DG CAAN.
In addition, procedures, regulations and forms that are specific to the procedures always require a
CAAN approval.
0.5.3 Licensing and Examination Division shall obtain prior approval of the DG, CAAN before
publication of any amendment. Exceptionally, if the amendment has an implication on safety, it
may be published and applied immediately, provided the required approval from DG, CAAN
has already been formally requested.
0.6. Issue and amendment date

The issue and amendment date shall be the date of CAAN approval letter, and the effective
date shall be as indicated in the manual and amendments. The holder of this requirement shall
be responsible for incorporating any necessary amendment.

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0.7. Requirement Distribution

Master Copy of this requirement shall be maintained in Technical Library, FSSD and shall be
published in CAAN Website. Copies of this requirement are distributed as per the
distribution list below:
SN Holder Hard Copy Soft Copy

1 Office of the Director General √
2 Office of Deputy Director General √
3 Chief, Flight Safety Standards Department √
4 Chief, Flight Operations Division √
5 Chief, Licensing and Examination Division √
6. ANSSD, CAAN √
7. All LED Personnel √
8. All CAAN Medical Assessors √
9. Technical Library, FSSD (Master Copy) √
For quick distribution electronic copies may be sent through e-mail.
0.8. Responsibility of the Requirement Holder

Each holder of the requirements is responsible for keeping their copy of the requirements up to
date, for entering the amendments and revisions correctly and for making sure that only the
current version is in use. On completion of every revision, each requirement holder must sign
and date the change in the Record of Revision. A copy of the signed Record of Revision shall be
forwarded to the Training Manager to aid in document control. For holders of electronic copies,
an email acknowledging receipt and understanding shall be sent to the Training Manager.
The requirement holder must study any amendment immediately upon receipt and insert the
revision in the requirement in accordance with the effective date of the Letter of Revision or at
first opportunity. All holders of the requirement are responsible to notify any discrepancy, error
or difficulty in interpretation to CAAN Licensing and Examination Division without delay.
0.9. List of Effective Pages

The List of Effective Pages (LEP) contained in front of the requirement lists all pages with their
issue dates. After a revision the manual must comply with the current LEP.

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PART 1
REQUIREMENTS FOR MEDICAL

EXAMINATION AND ASSESSMENT

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1.1 REQUIREMENT OF MEDICAL ASSESSMENT

1.1.1 Flight Crew Members, Air Traffic Controllers, and any other aviation personnel requiring
medical certification shall not exercise the privileges of their licence or certificate unless they
hold a current Medical Assessment as prescribed by the Civil Aviation Authority of Nepal.
a) Guidance material published in the Personnel Licensing Manual of CAAN shall be
referred to.
b) Applicants shall meet the prescribed licensing requirements of medical fitness for the
issue of various types of licences and certificates as mentioned in this requirement
and Personnel Licensing Requirements.
c) The licensing authority shall issue the licence holder with the appropriate medical
assessment, Class 1, Class 2 or Class 3 or as prescribed for certain licences and
certificates.
d) The medical assessment shall be issued in the prescribed format.
1.1.2 The medical assessment shall be an integral part of the licence or certificates (not
necessarily endorsed on the licence or certificate itself.
1.2 MEDICAL FORMS

Attachment one of this requirements comprises of medical forms as detailed below:
MED FORM Page Form Name

A-1/6 1-4 Application and Statement Form,
A-2/6 Medical Examination Form,
A-3/6 Medical Examination Form for Ear, Nose
& Throat Examination
A-4/6 Medical Examination Form for Eye,
Visual Acuity and Colour Perception.
A-5/6 5 Medical Assessment Form
A-6/6 6 Medical Certificate.
Medical Forms will be submitted in printed form. They are available from Flight Safety
Standards Department, Sinamangal, Kathmandu.
1.2.1 Designated Medical examiners shall have practical knowledge and experience of the
conditions in which the holders of licences and ratings carry out their duties.
1.3 MEDICAL HISTORY AND DECLARATION
1.3.1 The applicant shall furnish personal information regarding illness, injury, disability or
history pertaining to their medical fitness in the past as asked in the statement form and submit it
to the Designated Medical Examiner (DME) at the time of medical examination. The applicant

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will also provide contact details, including phone number, and is required to sign in an
appropriate place in the statement form. A false declaration may result in punitive action
considered appropriate by Aviation Enforcement Policy and Procedure Manual.
1.4 MEDICAL EXAMINATION
The medical examination shall cover the following three parts, as under:
1. Physical and Mental Examination,
2. Ear, Nose & Throat Examination and Hearing, and
3. Eye Examination, Visual Acuity &Colour Perception
1.4.1 Physical and mental requirements

An applicant for any class of medical assessment shall be required to be free from:
a) any abnormality, congenital or acquired; or
b) any active, latent, acute or chronic disability; or
c) any wound, injury or sequelae from operation; or
d) any effect or side-effect of any prescribed or non-prescribed therapeutic,
diagnostic or preventive medication taken such as would entail a degree of
functional incapacity which is likely to interfere with the safe operation of an
aircraft or with the safe performance of duties.
Note: The use of herbal medication and alternative treatments requires particular attention to
possible side-effects.
1.4.2. Visual acuity test requirements
The following shall be adopted for tests of visual acuity:
a) Visual acuity tests shall be conducted in an environment with a level of
illumination that corresponds to ordinary office illumination (30-60 cd/m2).
b) Visual acuity shall be measured by means of a series of Land oltrings or similar
optotypes, placed at a distance from the applicant appropriate to the method of
testing adopted.
1.4.3 Colour perception requirements
CAAN shall use methods of examination as will guarantee reliable testing of colour perception.
a. The applicant shall be required to demonstrate the ability to perceive readily those
colours the perception of which is necessary for the safe performance of duties.
b. The applicant shall be tested for the ability to correctly identify a series of pseudo iso-
chromatic plates in daylight or in artificial light of the same colour temperature such as
that provided by CIE standard illuminants C or D65 as specified by the International
Commission on Illumination (CIE).
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c. An applicant obtaining a satisfactory result as prescribed by the licensing authority shall

be assessed as fit. An applicant failing to obtain a satisfactory result in such a test shall be
assessed as unfit unless able to readily distinguish the colours used in air navigation and
correctly identify aviation coloured lights. Applicants who fail to meet these criteria shall
be assessed as unfit except for Class 2 assessment with the restriction: valid daytime
only.
d. Sunglasses worn during the exercise of the privileges of the licence or rating held should
be non-polarizing and of a neutral grey tint.
1.4.4Hearing test requirements

CAAN shall use methods of examination as will guarantee reliable testing of hearing.
a. Applicants shall be required to demonstrate a hearing performance sufficient for the safe
exercise of their licence and rating privileges.
b. Applicants for Class 1 medical assessments shall be tested by pure-tone audiometry at first
issue of the assessment, not less than once every five years up to the age of 40 years, and
thereafter not less than once every two years. Alternatively, other methods providing equivalent
results may be used.
c. Applicants for Class 3 medical assessments shall be tested by pure-tone audiometry at first
issue of the assessment, not less than once every four years up to the age of 40 years, and
thereafter not less than once every two years. Alternatively, other methods providing equivalent
results may be used.
d. Applicants for Class 2 medical assessments should be tested by pure-tone audiometry at first
issue of the assessment and, after the age of 50 years, not less than once every two years.
e. At medical examinations, other than those mentioned above, where audiometry is not
performed, applicants shall be tested in a quiet room by whispered and spoken voice tests.
f. The reference zero for calibration of pure-tone audiometers is that of the pertinent standards of
the current edition of the audiometric test methods, published by the International Organization
for Standardization (ISO).
g. For the purpose of testing hearing in accordance with the requirements, a quiet room is a room
in which the intensity of the background noise is less than 35 dB(a).
h. For the purpose of testing hearing in accordance with the requirements, the sound level of an
average conversational voice at 1 m from the point of output (lower lip of the speaker) is c. 60
dB(a) and that of a whispered voice c. 45dB(a). at 2 m from the speaker, the sound level is 6
dB(a) lower.
i. Private pilot licence holders requiring an instrument rating shall qualify for hearing acuity of
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1.4.5 Medical Tests Required
The following tests will be prescribed for initial licence issue: Urine (routine and microscopy),
complete blood count and ESR, random blood sugar, chest X-ray (PA view), electrocardiogram
and audiogram. Urine for albumin and sugar will be done at each medical. Other tests will be
prescribed as required periodically. These test requirements vary depending on Medical
Assessment Class. Additional tests will be required after the fortieth birthday viz. Blood sugar,
Lipid profile, Urine Routine and Microscopic examination, Echocardiogram and Exercise ECG
and then repeated periodically every five years in case of Class I Medical Assessment. In specific
cases further examinations and tests may be required. Tests required for Medical Assessment are
given in Appendix 1.
Each applicant will be examined by a DME, SME Eye and SME ENT and each will record their
findings in the respective part of the Medical Forms and give opinion as to the medical fitness of
the applicant. The applicant must confirm to the standards of medical fitness laid down in the
particular class of Medical Assessment in order to pass the medical examination. If there is any
finding outside the standards or any deficit or defect, numerically or otherwise, the DME will
record them and give their remarks or opinion.
1.5 MEDICAL ASSESSMENT
1.5.1 A Medical Assessment will be done by the Civil Aviation Medical Assessor (CAMA).
CAMA will evaluate the completed Statement Form duly filled out by the Applicant. The form
will be evaluated for completeness, any declaration about medical history, medical condition,
medical procedures, medications and any other related information provided. CAMA will also
look for consistency or discrepancy as compared to previous Statement Forms. CAMA will ask
for a detailed medical report as well as periodic medical review from the treating physician if any
medical condition is declared in the Statement Form.
1.5.2 The completed Medical Examination Form duly filled by CAME, DME Eye and DME
ENT will be evaluated for completeness of the form, examination findings of CAME and DMEs,
opinion of CAME and DMEs and remarks, if any. If needed, CAMA may ask for more detailed
evaluation and medical reports. Based on this, a medical assessment will be done as PASS,
DEFERRED or FAIL. A Medical assessment will need 7-10 days to complete. The applicants
are expected to submit their Statement Form and Medical Examination Form well in advance of
their licence expiry date in order to facilitate completion of the medical assessment in time.
1.5.3 If the licence is DEFERRED for any reason, a reassessment will be done after reviewing all
the medical documents in detail. The Medical Assessor may request a more detailed evaluation
by a specialist in various medical fields, as needed. After scrutinizing all the available documents
in detail, a final medical assessment will be done. This process may take 2-4 weeks.
1.5.4 For those who FAIL a medical assessment, the final decision will be communicated
through an appropriate channel. There is a provision for appeal as per section 1.15. To maintain
medical confidentiality, no inquiry about medical status of an applicant will be entertained from

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any unauthorised person and final opinion will be communicated through a proper channel after
satisfying all aspect of medical examination.
1.5.5If there is finding outside the standards or any deficit or defect, numerically or otherwise,
that is unlikely to interfere with the safe exercise of the applicant's licence, the CAMA may
assess the applicant as medically fit and recommend a limitation or endorsement if deemed
necessary for the sake of flight safety.
1.5.6An applicant who has passed the medical assessment is considered physically and mentally
fit for performing their duties and also that they will remain so for the period of validity of the
licence.
1.6 MEDICAL CONFIDENTIALITY
1.6.1 Medical confidentiality shall be respected at all times.

1.6.2 All medical reports and records shall be securely held with accessibility restricted to
authorised personnel. When justified by operational considerations, the civil aviation medical
assessor (CAMA) shall determine to what extent pertinent medical information is presented to
relevant officials of the Licensing Authority.
1.7 MEDICAL FITNESS

The applicant should satisfy the CAME, DMEs and CAMA that they are medically fit to exercise
the privilege of the licence as per the medical standards for licensing. If there is any doubt as to
their medical fitness, further examinations or tests or opinion from medical experts will be
required.
1.8 DECREASE IN MEDICAL FITNESS

It is a state or period when there is diminished medical fitness which may be attributable to
illness, injuries, drugs, or physical, physiological or mental stresses or there is finding outside the
prescribed normal ranges, which lasts for certain period of time and is of temporary nature.
If the applicant is aware, or has reason to believe, that their physical or mental or sensory
faculties have decreased, as a result of common ailments, or fasting or fatigue or tension or
drugs, injuries, accident, operation, invasive procedures or hospitalization, etc. to a degree which
could jeopardize flight safety, they will defer their medical examination until their physical or
mental or sensory faculties have fully recovered. The licence holder shall not utilize the privilege
of their licence until they have fully recovered.
Such cases should be notified to the CAME or DMEs at the time of medical examination by the
licence holder or the airline in writing to CAMA or LED. All relevant medical reports or
documents must also be submitted.
Decrease in medical fitness can usually be assumed to be present in the following situations:
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1. Aftersevere illness, injuries, accident, operation, invasive procedures or hospitalization,

2. Incapacitation for more than 21 days,
3. Problematic use of substances or illicit drugs,
4. Being pregnant
The applicantwill be required to undergo a medical examination and assessment and be certified
medically fit before again exercising the privilege of their licence.
1.9 BORDERLINE MEDICAL FINDING
In case of a finding which is outside the prescribed normal range or undesirable or indicative of
early sign of disease process, but not necessarily likely to cause incapacitation or jeopardize the
flight safety, the CAMA will inform the applicant or licence holder and may ask for further tests,
further opinion from experts or advise the applicant to see an airline doctor or their personal
doctor to take timely precautions.
1.10 ACCREDITED MEDICAL OPINION

If the applicant for or the holder of a licence does not meet the requirements or is found to have
any condition due to illness, injury or operation or sequalae therefrom which causes or may
cause incapacitation interfering with the performance of duties, further evaluation from a
specialist and additional tests may be required. Such cases may be referred to specialists or
experts for their opinion by CAMA. Opinion received from such special medical evaluation is
called 'Accredited Medical Opinion'. If accredited medical opinion certifies the applicant as
medically fit, it indicates that applicant's or holder's failure to meet any requirement is not likely
to jeopardize flight safety. The relevant ability, skill and experience of the applicant and
operational conditions are given due consideration in such an evaluation. It may be endorsed by
CAMA with limitations or restrictions if necessary, for the sake of flight safety.
1.11 MEDICAL FLIGHT TEST

Where there is some question as to the degree of decreased physical ability or functional
limitation, an applicant may be tested in actual flight to see if they can operate the aircraft
without compromising the flight safety during routine and emergencies. This will be done under
the supervision of an instructor pilot, and preferably with CAMA and can also be combined with
a pilot proficiency check.
1.12 FLEXIBILITY CLAUSE

If the applicant has a deficit or defect, numerical or otherwise, that may cause a degree of
functional incapacity; CAMA can recommend renewal of a licence, with the evidence that the
applicant has already acquired and demonstrated ability, skill and experience which could
compensate for the failure to meet the prescribed medical standard. The deficit or defect must be
shown to not produce any hazard either of incapacity or of inability to perform their duty safely.
However, this provision may be applied with endorsements e.g. operational or multi-crew
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limitation or restriction, assistance like glasses, additional tests in medical examination, frequent
medical examination, etc. It will be done usually on an 'accredited medical opinion'. This is
popularly called a 'waiver' and an applicant shall be assessed as 'fit' under 'flexibility clause' only
after careful consideration of all aspects of the individual case.
1.13 MEDICALLY UNFIT OR DEFERRED MEDICAL ASSESSMENT

If the applicant for a licence, whether it be initial or renewal, does not clearly meet the medical
requirements or is found to have any condition due to illness, injury or operation or sequalae
therefrom or influence of psycho-active substances or problematic use of substances or drugs,
which causes or may cause incapacitation interfering with the performance of duties safely, they
will not pass the medical assessment. The applicant will be certified medically unfit. However, in
case of doubt, medical assessment is deferred until further evaluation is done and information
gathered. Final certification is made whether medically fit or unfit only after consideration of the
full set of details.
1.14 SUSPENSION OF LICENCE ON MEDICAL REASON

Should a licence holder fail to meet the medical requirements they will be notified that their
licence shall be suspended. They may then undergo another medical examination and submit
reports about their diagnosis, treatment and progress from their treating doctor. Should their
recovery be slow, they may submit reports at least every six months to the CAMA for
consideration. If their recovery takes longer than two years, they will then be considered as a
new applicant for the licence.
1.15 PROVISION OF APPEAL

If a licence is denied, or suspended or deferred on medical grounds and the applicant for, or
holder of a licence is not satisfied, then the applicant or holder has the right of appeal to Director
General, CAAN within the period of 45 days from the date of notification of the decision. The
DG CAAN in turn may request a second medical opinion.
1.16 EXPIRED LICENCE DUE TO MEDICAL REASON

Any flight crew or air traffic controller whose licence has expired due to medical reasons must
undergo a medical examination and assessment and be assessed medically fit for the reissue of
the licence. During the medical examination the licence holder should submit full medical
reports from the treating physician with all the investigations and treatment, and report that they
have fully recovered from the disqualifying medical condition. If the licence holder has missed
two consecutive medical examinations from the expiration of the licence, the medical
examination will be as if for the initial issue of licence and other tests may be required.

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1.17 VALIDATION OF FOREIGN LICENCE

Validation of foreign licences will be done by LED of CAAN if the licence holder can provide
evidence that they have complied with equivalent licence requirements, including a medical
assessment in the State of the issue of the licence.
CAAN reserves the right to demand additional tests, a medical examination and assessment of a
foreign licence holder to ascertain their medical fitness and ability to comply with the medical
requirements of CAAN.
1.18 DISPENSATION OF MEDICAL EXAMINATION AND

ASSESSMENT
If a licence holder is based in a region where medical examination is not possible, the period of
validity of a Medical Assessment may be extended, at the discretion of the Civil Aviation
Authority of Nepal, up to 45 days (as per Annex 1 and PeLR 1.19.3). The reason for seeking an
extension must be clearly stated and should satisfy CAMA and LED. An extension may be done
once only. CAMA and LED have right to refuse extension. Such a licence holder should forward
to LED a medical certificate from a local registered practitioner declaring their medical fitness in
accordance with the Medical Requirements, if possible.
1.19 EXCEEDING CUMULATIVE FLIGHT HOURS LIMITATION

The privileges of a licence will automatically cease the moment the crew member reaches the
cumulative flight hours limitation as laid down in FOR. However, in special circumstances
licence suspension may be waived if the there is a written application and LED is satisfied the
applicant is medically fit. A medical examination must be carried out and the CAMA be satisfied
and certifies the applicant as medically fit. CAMA will specifically ensure that there are no
symptoms and signs of fatigue. This will be in exceptional situation and for the shortest possible
period only.
1.20 FEE
The fees and expenditure for medical examination, tests, medical assessment and evaluation by
specialist or experts (accredited medical opinion), medical flight tests and second opinion after
appeal, will be borne by the applicant or their concerned institution. The fee structure will be
reviewed by CAAN as required normally in three years.
1.21 DESIGNATED MEDICAL EXAMINER (DME)

1.21.1 The Designated Medical Examiners (DME) are medical practitioners designated by Civil
Aviation Authority of Nepal who will perform the medical examination of aviation
professionals for the purpose of personnel licensing.
1.21.2 In order to be designated as DME, an applicant shall have:

a) Nepalese citizenship certificate;
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b) Medical graduate or MBBS certificate;

c) Post-graduate MD (Internal Medicine or General Practice) or equivalent
d) Evidence of experience of at least two years practice in that specialty;
e) Registration with Nepal Medical Council;
f) Basic training in Aviation Medicine of 60 hours or equivalent
(competency based);
h) Pass an interview/oral examination conducted by CAAN to demonstrate their
competency.
i) Experience of the working environment of both pilot and air traffic controller
k) Satisfactorily demonstrated affiliation with a recommended hospital or clinic
for clinical examination.
1.21.3 DME will be designated among the applicants based on competency and experience in
aviation medicine. A board formed by CAAN comprising of CAMA and FSSD
authorities will evaluate applicants for competency and DME will be designated based on
merit.
1.21.4 They are also required to attend refresher training in aviation medicine once in every two
years to maintain professional competency. The refresher training will be at least half a
day and will be conducted in Kathmandu.
1.21.5They shall also have knowledge, familiarity and training in Aviation Medicine. A post-
graduate qualification in aviation medicine will be an added advantage.
1.21.6Once designated by the Civil Aviation Authority as CAME or DME, they shall be
authorised to conduct Class I/II/III Medical Examination.
1.21.7 The CAME and DME shall forward a Medical Report to the Civil Aviation Medical
Assessor for final assessment. They must ensure a thorough examination.
1.21.8The DME shall have access to medical examination related documents like Annex 1,
PELR, Personnel Licensing Manual, Medical Requirements, Medical Manual, and
relevant documents from Licensing and Examination Division.
1.21.9The CAME and DME shall exhibit the conduct and behaviour commensurate with their
position and will always abide by the rules and regulations of CAAN.
1.21.10Adequate enforcement action will be taken against the DME if they are found not
performing up to the standard and contravening the CAAN or applicable rules and
regulations of Nepal including those of Nepal Medical Council (NMC).
1.21.11 There will be an annual surveillance plan of the DMEs, and they shall be responsible to
be available for inspection by the team of CAAN including the CAMA.
1.21.12 The DME shall report to LED FSSD CAAN any false declaration made by the applicant
in the process of applying for a medical certificate.
Amdt. No- 02 CIVIL AVIATION AUTHORITY OF NEPAL Page 1- 10

Amdt. Date 17 March 2023
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1.21.13The tenure of a CAME or DME will be for two years unless suspended, revoked or
surrendered. The extension of the term for subsequent years will be dependent on the
satisfactory inspection report following the annual surveillance program.
1.21.14The tenure of a DME will not be extended in the event of the DME failing to demonstrate
satisfactory performance.
1.21.15The purpose of such auditing is to ensure that the DMEs meet applicable standards for
good medical practice and aeromedical risk assessment. Guidance on aeromedical risk
assessment is contained in the Manual of Civil Aviation Medicine (Doc 8984).
1.22 SPECIALIST MEDICAL EXAMINER (SME)
1.22.1 The Specialist Medical Examiners (SME) are medical practitioners specialised in fields of
Ophthalmology (Eye) or Oto-rhino-laryngology (ENT) designated by Civil Aviation
Authority of Nepal who will perform the medical examination of aviation professionals
for the purpose of personnel licensing.
1.22.2 In order to be designated as SME, an applicant shall have:

a) Nepalese citizenship certificate.
b) Medical graduate or MBBS certificate.
c) Post-graduate MD/MS in Ophthalmology (Eye) or Oto-rhino-laryngology
(ENT) or equivalent.
d) Evidence of experience of at least two years practice in that specialty.
e) Registration with Nepal Medical Council.
f) Experience of working environment of pilot and air traffic controller.
k) Satisfactorily demonstrated affiliation with a recommended hospital or clinic
for clinical examination.
1.22.2 SME will be designated among the applicants based on competency and experience in
aviation medicine.
1.22.3 They are also required to attend refresher training in aviation medicine once in every two
years to maintain professional competency. The refresher training will be at least half a
day and will be conducted in Kathmandu.
1.22.4 After designation SME will have to attend tower visit organized by FSSD to get
familiarized with working environment of Air Traffic Controllers (ATCs).
1.22.5 Once designated by the Civil Aviation Authority as SME, they shall be authorised to
conduct Class I/II/III Medical Examination.
1.22.6 The SME shall forward a Medical Report to the Civil Aviation Medical Assessor for final
assessment. They must ensure thorough examination.

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1.22.7 The SME shall have access to medical examination related documents like Annex 1,
PELR, Personnel Licensing Manual, Medical Requirements, Medical Manual, and
relevant documents from Licensing and Examination Division.
1.22.8 The SME shall exhibit the conduct and behaviour commensurate with their position and
will always abide by the rules and regulations of CAAN.
1.22.9 Adequate enforcement action will be taken against the SME if they are found not
performing up to the standard and contravening the CAAN or applicable rules and
regulations of Nepal including those of Nepal Medical Council (NMC).
1.22.10 There will be an annual surveillance plan of the SMEs and they shall be responsible to
be available for inspection by the team of CAAN including the CAMA.
1.22.11 The SME shall report to LED FSSD CAAN any false declaration made by the applicant
in the process of applying for a medical certificate.
1.22.12 The tenure of a SME will be for two years unless suspended, revoked or surrendered.
The extension of the term for subsequent years will be dependent on the satisfactory
inspection report following the annual surveillance program.
1.22.13 The tenure of a SME will not be extended in the event of the SME failing to demonstrate
satisfactory performance.
1.22.14 The purpose of such auditing is to ensure that SME meet applicable standards for good
medical practice and aeromedical risk assessment. Guidance on aeromedical risk
assessment is contained in the Manual of Civil Aviation Medicine (Doc 8984).
1.23 CIVIL AVIATION MEDICAL ASSESSOR (CAMA)

1.23.1 Civil Aviation Authority of Nepal will appoint a Civil Aviation Medical Assessor
(CAMA).
1.23.2 The minimum qualifications for the CAMA shall be as following:
a) Medical graduate or MBBS certificate;
b) Registration in Nepal Medical Council
c) Post-graduate MD (Internal Medicine or General Practice) or equivalent
d) Advanced training in Aviation Medicine of 120 hours or equivalent
and evidence of experience of at least two years practice as a DME; or
Advanced training in Aviation Medicine of 60 hours or equivalent and
evidence of experience of at least five years as a DME.
1.23.3 The desirable qualifications will be as following:

a) Familiarisation Training in Aircraft Accident investigation
b) Familiarisation Training in ICAO Annex -1 and ICAO USOAP Training
c) Civil Aviation and related regulatory courses
Amdt. Date April 01, 2021
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1.23.4The Aviation Medical Assessor will scrutinize the findings recorded in the Medical Forms,
Attachment 1, and make an assessment and recommendation to the Licensing and
Examination Division. The DME and SMEs may also inform the applicant of the
presence of any risk factors or early warning signs of disease which do not clearly fall
below the prescribed standards and advise them to take preventive measures.
1.23.5 The Civil Aviation Medical Assessor also deals with related matters regarding medical
examination and assessment of the applicants or licence holders.
1.23.6 The CAMA may also act as a DME within their specialty but must ensure that any
potential conflict of interest is avoided.
1.23.7 The CAMA will help organise, and participate in, DME and SME orientation and training
programmes including refresher training in Aviation Medicine. They shall arrange visits
in towers and cockpit with the help of CAAN to orient and familiarize the CAMEs and
DMEs with aviation medicine and working environments.
1.23.8 The CAMA will monitor and assess the performance of DMEs and SMEs and will report
to CAAN any need of enforcement action if situation so demands during the inspection or
surveillance.
1.23.9 The CAMA will also advise the Director General of CAAN in Aviation matters related to
health and safety.
1.23.10 To gain practical knowledge and experience of the conditions in which the licence
holders carry out their duties, CAMA will acquire flight deck experience of at least ten
hours per year in aircraft engaged in commercial operation as well as experience in the
operational working conditions of air traffic controllers.
1.23.11 CAMA shall attend Domestic/International Aviation Medicine scientific meetings,

conferences or courses periodically. Preference will be given to meetings, conferences
or courses which are recognized as refresher training by ICAO/EASA/FAA. The cost for
attending such meetings, conferences or courses will be borne by CAAN as required.
1.24 MEDICAL ASSESSMENT CLASSES
1.24.1 The Medical Assessment Classes are three viz. I,II and III. The applicant must pass the
respective medical assessment class and be certified medically depending on the type of
licences, as tabulated here.

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Medical Assessment Class Type of Licences

Commercial Pilot
I Multi crew Pilot
Airline Transport Pilot
Private Pilot
II Microlight Pilot
Free Balloon Pilot
Glider Pilot
Ultra-Light Pilot
Flight engineer
III Air Traffic Controller
1.25 VALIDITY PERIOD OF MEDICAL ASSESSMENT
1.25.1 The validity period of a medical assessment varies with the type of licence and age of the
crew member. For the initial issue it begins on the day of the medical assessment and
ends on the last day of the preceding calendar month of the validity period.
1.25.2 In case of renewal of a licence, the medical examination and assessment is done during
the last month of the validity period of the licence. The validity period of the medical
assessment will be for the period of remaining days of that month, plus 6 or 12 or 24
calendar months as determined by 1.26 below.
1.26 MEDICAL VALIDITY
1.26.1 Period of Medical Validity and Validity of Licence

1.26.1.1A medical assessment issued shall be valid from the date of the medical examination for
a period not greater than:
a) 60 months for the Private Pilot Licence – aeroplane, airship, helicopter and powered-lift;
b) 12 months for the Commercial Pilot Licence – aeroplane, airship, helicopter, and
powered-lift;
c) 12 months for the Multi-crew Pilot Licence – aeroplane;
d) 12 months for the Airline Transport Pilot Licence – aeroplane, helicopter and powered-
lift;
e) 24 months for the Ultra-light Pilot Licence;
f) 24 months for the Glider Pilot Licence;
g) 24 months for the Free Balloon Pilot Licence;
h) 24 months for the Flight Engineer Licence;

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i) 48 months for the Air Traffic Controller Licence;

1.26.1.2 As per section 1.18 above, the period of validity of a Medical Assessment may be
extended, at the discretion of the Civil Aviation Authority of Nepal, up to 45 days (as
per Annex 1 and PeLR 1.19.3)
1.26.1.3 The period of validity will, for the last month counted, include the day that has the same
calendar number as the date of the medical examination or, if that month has no day
with that number, the last day of that month.
1.26.1.4 The period of validity of a medical assessment shall be reduced when clinically
indicated.
1.26.2 REDUCTION OF MEDICAL VALIDITY WITH AGE

1.26.2.1 When the holders of Airline Transport Pilot Licences, Commercial Pilot Licences and
Multi-Crew Pilot Licences, who are engaged in commercial air transport operations,
have passed their 60th birthday, the period of validity shall be reduced to six months.
1.26.2.2 When the holders of Airline Transport Pilot Licences and Commercial Pilot Licences —
aeroplane, helicopter, powered-lift and airship, who are engaged in single-crew
commercial air transport operations carrying passengers, have passed their 40th birthday,
the period of validity shall be reduced to six months.
1.26.2.3When the holders of Private Pilot Licences — aeroplane, helicopter, powered-lift,
airship, Glider Pilot Licences, Free Balloon Pilot Licences, and Air Traffic Controller
Licences have passed their 50th birthday, the period of validity shall be reduced to 12
months. (the periods of validity listed above are based on the age of the applicant at the
time of undergoing the medical examination)
1.26.3 THE 60-65 YEARS RULE

 Permission to act as flight crew is also dependent on the age provisions set out in
Personnel Licensing Requirements.

 Prescribed medical and licensing restrictions shall apply.
1.27 AGE
The minimum age for various licences shall be as per the applicable class of licence as
defined in PELR.

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1.28 HEIGHT
As a rule, no height will bar the applicant from obtaining a licence. However, in cases an actual
test in the cockpit regarding accessibility and manoeuvrability of controls and instruments with
seat adjustments will be tested before assessing an applicant as 'fit'.
1.29 WEIGHT
As a rule, no weight will bar the applicant from obtaining a licence. However, those with
excessive weight or who are obese i.e. Body Mass Index [BMI = weight (kg)/height (m 2)]> 30,
will be discouraged from taking up the flying profession especially if the family has a history of
diabetes, coronary artery disease or hypertension. In grossly obese (BMI > 40) cases an actual
test in the cockpit regarding accessibility and manoeuvrability of controls and instruments with
seat adjustments will be tested before assessing an applicant as 'fit'.

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PART 2
MEDICAL STANDARDS
FOR
LICENSING REQUIREMENTS

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PART 2 MEDICAL STANDARDS FOR LICENCING REQUIREMENTS-

This part sets medical standards for licensing requirements.
2.1 Medical Assessments — General
2.1.1 Classes of Medical Assessment

Medical Assessment are established as follows:
a) Class 1 Medical Assessment; applies to applicants for, and holders of:

— Commercial pilot licences — aeroplane, airship, helicopter and powered-lift
— Multi-crew pilot licences — aeroplane
— Airline transport pilot licences — aeroplane, helicopter and powered-lift
b) Class 2 Medical Assessment; applies to applicants for, and holders of:
— Flight navigator licences
— Flight engineer licences
— Private pilot licences — aeroplane, airship, helicopter and powered-lift
— Glider pilot licences
— Free balloon pilot licences

— Ultralight Pilot licences
c) Class 3 Medical Assessment; applies to applicants for, and holders of:

— Air traffic controller licences.

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2.1.2 The applicant for a Medical Assessment shall provide the medical examiner with a personally certified statement of medical
facts concerning personal, familial and hereditary history. The applicant shall be made aware of the necessity for giving a statement
that is as complete and accurate as the applicant‘s knowledge permits, and any false statement shall be dealt with in accordance
with Aviation Enforcement Procedure Manual (AEPM).
2.1.3 The DME shall report to the Civil Aviation Authority of Nepal any individual case where, in the examiner‘s judgement, an
applicant‘s failure to meet any requirement, whether numerical or otherwise, is such that exercise of the privileges of the licence
being applied for, or held, is not likely to jeopardise flight safety.
2.1.4 The level of medical fitness to be met for the renewal of a Medical Assessment shall be the same as that for the initial
assessment except where otherwise specifically stated.
2.2 Requirements for Medical Assessments
2.2.1 General
An applicant for a Medical Assessment shall undergo a medical examination based on the following requirements:
a) physical and mental;
b) visual and colour perception; and
c) hearing.
2.2.2 Physical and mental requirements

An applicant for any class of Medical Assessment shall be required to be free from:
a) any abnormality, congenital or acquired; or
b) any active, latent, acute or chronic disability; or

c) any wound, injury or sequelae from operation; or
d) any effect or side-effect of any prescribed or non-prescribed therapeutic, diagnostic or preventive medication taken;

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2.2.3 Visual acuity test requirements
2.2.3.1 The methods in use for the measurement of visual acuity are likely to lead to differing evaluations. To achieve uniformity,
therefore, Medical Assessor shall ensure that equivalence in the methods of evaluation be obtained.
2.2.4 Colour perception requirements
2.2.4.1 Civil Aviation Authority of Nepal shall use such methods of examination as will guarantee reliable testing of colour
perception.
2.2.4.2 The applicant shall be required to demonstrate the ability to perceive readily those colours the perception of which is
necessary for the safe performance of duties.
2.2.4.3 The applicant shall be tested for the ability to correctly identify a series of pseudoisochromatic plates in daylight or in
artificial light of the same colour temperature such as that provided by CIE standard illuminants C or D65 as specified by the
International Commission on Illumination (CIE).
2.2.4.4 An applicant obtaining a satisfactory result as prescribed by the Civil Aviation Authority of Nepal shall be assessed as fit.
An applicant failing to obtain a satisfactory result in such a test shall be assessed as unfit unless able to readily distinguish the
colours used in air navigation and correctly identify aviation coloured lights. Applicants who fail to meet these criteria shall be
assessed as unfit except for Class 2 assessment with the following restriction: valid daytime only.
2.2.4.4.1Sunglasses worn during the exercise of the privileges of the licence or rating held should be non-polarizing and of a neutral
grey tint.
2.2.5 Hearing test requirements
2.2.5.1 Civil Aviation Authority of Nepal shall use such methods of examination as will guarantee reliable testing of hearing.

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2.2.5.2 Applicants shall be required to demonstrate a hearing performance sufficient for the safe exercise of their licence and rating
privileges.
2.2.5.3 Applicants for Class 1 Medical Assessments shall be tested by pure-tone audiometry at first issue of the Assessment, not
less than once every five years up to the age of 40 years, and thereafter not less than once every two years.
2.2.5.3.1 Alternatively, other methods providing equivalent results may be used.
2.2.5.4 Applicants for Class 3 Medical Assessments shall be tested by pure-tone audiometry at first issue of the Assessment, not
less than once every four years up to the age of 40 years, and thereafter not less than once every two years.
2.2.5.4.1 Alternatively, other methods providing equivalent results may be used.
2.2.5.4.2 Applicants for Class 2 Medical Assessment should be tested by pure-tone audiometry at first issue of the Assessment and, after the
age of 50 years, not less than once every two years.
2.2.5.6 At medical examinations where audiometry is not performed, applicants shall be tested in a quiet room by whispered and
spoken voice tests.
Note 1. — The reference zero for calibration of pure-tone audiometers is that of the pertinent Standards of the current edition of
the Audiometric Test Methods, published by the International Organization for Standardization (ISO).
Note 2.— For the purpose of testing hearing in accordance with the requirements, a quiet room is a room in which the intensity of
the background noise is less than 35 dB(A).
Note 3.— For the purpose of testing hearing in accordance with the requirements, the sound level of an average conversational
voice at 1 m from the point of output (lower lip of the speaker) is c. 60 dB(A) and that of a whispered voice c. 45dB(A). At 2 m from
the speaker, the sound level is 6 dB(A) lower.
Note 4.— Guidance on assessment of applicants who use hearing aids is contained in the Manual of Civil Aviation Medicine (Doc
8984).

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Class 1 Medical Assessment (C1) Class 2 Medical Assessment (C2) Class 3 Medical Assessment (C3)
C1 Assessment issue and renewal C2 Assessment issue and renewal C3. Assessment issue and renewal
C1.1 An applicant for a commercial pilot C2.1 An applicant for a private pilot licence — C3.1 An applicant for an air traffic controller
licence — aeroplane, airship, helicopter or aeroplane, airship, helicopter or powered-lift, a licence shall undergo an initial medical
powered-lift, a multi-crew pilot licence — glider pilot licence, a free balloon pilot licence, examination for the issue of a Class 3 Medical
aeroplane, or an airline transport pilot licence — UPL, a flight engineer licence or a flight navigator Assessment.
aeroplane, helicopter or powered-lift shall licence shall undergo an initial medical
undergo an initial medical examination for the examination for the issue of a Class 2 Medical
issue of a Class 1 Medical Assessment. Assessment.
C1.1.2.Except where otherwise stated in this C2.1.2 Except where otherwise stated in this C3.1.2 Except where otherwise stated in this
section, holders of commercial pilot licences — section, holders of private pilot licences — section, holders of air traffic controller licences
aeroplane, airship, helicopter or powered-lift, aeroplane, airship, helicopter or powered-lift, shall have their Class 3 Medical Assessments
multi-crew pilot licences — aeroplane, or airline glider pilot licences, free balloon pilot licences, renewed at intervals not exceeding those specified
transport pilot licences — aeroplane, helicopter or flight engineer licences or flight navigator licences in 1.26.
powered-lift will have their Class 1 Medical shall have their Class 2 Medical Assessments
Assessments renewed at intervals not exceeding renewed at intervals not exceeding those specified
those specified in 1.26. in 1.26.
C1.1.3 When the medical assessor is C2.1.3 When the medical assessor is satisfied C3.1.3 When the medical assessor is satisfied
satisfied that the requirements of this section that the requirements of this section and the that the requirements of this section and the
and the general provisions have been met, a general provisions have been met, a Class 2 general provisions have been met, a Class 3
Class 1 Medical Assessment may be issued Medical Assessment may be issued to the Medical Assessment may be issued to the
to the applicant. applicant. applicant

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C1.1.4Physical and mental requirements C2.1.4Physical and mental requirements C3.1.4Physical and mental requirements
The medical examination for a class 1 Medical The medical examination for a class 2 Medical The medical examination for a class 3 Medical
Assessment shall be based on the following Assessment shall be based on the following Assessment shall be based on the following
requirements. requirements. requirements.
General General General

C1.2 The applicant shall not suffer from any C2.2 The applicant shall not suffer from any C3.2 The applicant shall not suffer from any
disease or disability which could render that disease or disability which could render that disease or disability which could render that
applicant likely to become suddenly unable either applicant likely to become suddenly unable either applicant likely to become suddenly unable to
to operate an aircraft safely or to perform to operate an aircraft safely or to perform assigned perform duties safely.
assigned duties safely. duties safely.
Mental health and Mental health and Mental health and
behavioural behavioural behavioural
C1.3 The applicant shall have no established C2.3 The applicant shall have no established C3.3 The applicant shall have no established
medical history or clinical diagnosis of: medical history or clinical diagnosis of: medical history or clinical diagnosis of:
a) an organic mental disorder; a) an organic mental disorder; a) an organic mental disorder;
b) a mental or behavioural disorder due to use b) a mental or behavioural disorder due to b) a mental or behavioural disorder due to
of psychoactive substances; this includes psychoactive substance use; this includes psychoactive substance use; this includes
dependence syndrome induced by alcohol dependence syndrome induced by alcohol dependence syndrome induced by alcohol
or other psychoactive substances; or other psychoactive substances; or other psychoactive substances;
c) schizophrenia or a schizotypal or c) schizophrenia or a schizotypal or c) schizophrenia or a schizotypal or delusional
delusional disorder; delusional disorder; disorder;
d) a mood (affective) disorder; d) a mood (affective) disorder; d) a mood (affective) disorder;
e) a neurotic, stress-related or somatoform e) a neurotic, stress-related or somatoform
disorder; disorder; e) a neurotic, stress-related or somatoform
f) a behavioural syndrome associated with f) a behavioural syndrome associated with disorder;
physiological disturbances or physical physiological disturbances or physical f) a behavioural syndrome associated with
factors; factors; physiological disturbances or physical
g) a disorder of adult personality or g) a disorder of adult personality or behaviour, factors;
behaviour, particularly if manifested by particularly if manifested by repeated overt g) a disorder of adult personality or behaviour,
repeated overt acts; acts; particularly if manifested by repeated overt
acts;
h) mental retardation; h) mental retardation; h) mental retardation;

i) a disorder of psychological development; i) a disorder of psychological development; i) a disorder of psychological development;
j) a behavioural or emotional disorder, with j) a behavioural or emotional disorder, with j) a behavioural or emotional disorder, with

5th Edition
onset in childhood or adolescence; or onset in childhood or adolescence; or onset in childhood or adolescence; or

k) a mental disorder not otherwise specified; k) a mental disorder not otherwise specified; k) a mental disorder not otherwise specified;
such as might render the applicant unable to such as might render the applicant unable to safely such as might render the applicant unable to safely
safely exercise the privileges of the licence exercise the privileges of the licence applied for or exercise the privileges of the licence applied for or
applied for or held. held. held
C1.3.1 An applicant with depression, being C2.3.1 An applicant with depression, being C3.3.1 An applicant with depression, being
treated with antidepressant medication, treated with antidepressant medication, should treated with antidepressant medication, should
should be assessed as unfit unless the medical be assessed as unfit unless the medical beassessed as unfit unless the medical
assessor, having access to the details of the assessor, having access to the details of the assessor, having access to the details of the
case concerned, considers the applicant‘s case concerned, considers the applicant‘s case concerned, considers the applicant‘s
condition as unlikely to interfere with the condition as unlikely to interfere with the safe condition as unlikely to interfere with the safe
safe exercise of the applicant‘s licence and exercise of the applicant‘s licence and rating exercise of the applicant‘s licence and rating
rating privileges. privileges privileges.
Note 1.— Guidance on assessment of applicants Note 1.— Guidance on assessment of applicants Note 1.— Guidance on assessment of applicants
treated with antidepressant medication is treated with antidepressant medication is contained treated with antidepressant medication is contained
contained in the ICAO Manual of Civil Aviation in the ICAO Manual of Civil Aviation Medicine in the ICAO Manual of Civil Aviation Medicine
Medicine (Doc 8984). (Doc 8984). (Doc 8984).
Note 2.— Mental and behavioural disorders are Note 2.— Mental and behavioural disorders are Note 2.— Mental and behavioural disorders are
defined in accordance with the clinical descriptions defined in accordance with the clinical descriptions defined in accordance with the clinical descriptions
and diagnostic guidelines of the World Health and diagnostic guidelines of the World Health and diagnostic guidelines of the World Health
Organization as given in the International Statistical Organization as given in the International Statistical Organization as given in the International Statistical
Classification of Diseases and Related Health Classification of Diseases and Related Health Classification of Diseases and Related Health
Problems, 10th Edition — Classification of Mental Problems, 10th Edition — Classification of Mental Problems, 10th Edition — Classification of Mental
and Behavioural Disorders, WHO 1992. This and Behavioural Disorders, WHO 1992. This and Behavioural Disorders, WHO 1992. This
document contains detailed descriptions of the document contains detailed descriptions of the document contains detailed descriptions of the
diagnostic requirements, which may be useful for diagnostic requirements, which may be useful for diagnostic requirements, which may be useful for
their application to medical assessment. their application to medical assessment. their application to medical assessment.

5th Edition
Neurological Neurological Neurological

C1.4 The applicant shall have no established C2.4 The applicant shall have no established C3.4 The applicant shall have no established
medical history or clinical diagnosis of any of the medical history or clinical diagnosis of any of the medical history or clinical diagnosis of any of the
following: following: following:
a) a progressive or non-progressive disease of a) a progressive or non-progressive disease of a) a progressive or non-progressive disease of
the nervous system, the effects of which the nervous system, the effects of which are the nervous system, the effects of which are
are likely to interfere with the safe exercise likely to interfere with the safe exercise of likely to interfere with the safe exercise of
of the applicant‘s licence and rating the applicant‘s licence and rating the applicant‘s licence and rating
privileges; privileges; privileges;
b) epilepsy; or b) epilepsy; b) epilepsy; or
c) any disturbance of consciousness without c) any disturbance of consciousness without c) any disturbance of consciousness without
satisfactory medical explanation of cause. satisfactory medical explanation of cause. satisfactory medical explanation of cause.
C1.4.1 The applicant shall not have suffered any C2.4.1 The applicant shall not have suffered any C3.4.1 The applicant shall not have suffered any
head injury, the effects of which are likely to head injury, the effects of which are likely to head injury, the effects of which are likely to
interfere with the safe exercise of the applicant‘s interfere with the safe exercise of the applicant‘s interfere with the safe exercise of the applicant‘s
licence and rating privileges. licence and rating privileges. licence and rating privileges.

5th Edition
Cardiovascular Cardiovascular Cardiovascular

C1.5 The applicant shall not possess any C2.5 The applicant shall not possess any C3.5 The applicant shall not possess any
abnormality of the heart, congenital or acquired, abnormality of the heart, congenital or acquired, abnormality of the heart, congenital or acquired,
which is likely to interfere with the safe exercise which is likely to interfere with the safe exercise which is likely to interfere with the safe exercise
of the applicant‘s licence and rating privileges. of the applicant‘s licence and rating privileges. of the applicant‘s licence and rating privileges.
C1.5.1An applicant who has undergone coronary C2.5.1An applicant who has undergone coronary C3.5.1An applicant who has undergone coronary
bypass grafting or angioplasty (with or without by-pass grafting or angioplasty (with or without bypass grafting or angioplasty (with or without
stenting) or other cardiac intervention or who has stenting) or other cardiac intervention or who has a stenting) or other cardiac intervention or who has a
a history of myocardial infarction or who suffers history of myocardial infarction or who suffers history of myocardial infarction or who suffers
from any other potentially incapacitating cardiac from any other potentially incapacitating cardiac from any other potentially incapacitating cardiac
condition shall be assessed as unfit unless the condition shall be assessed as unfit unless the condition shall be assessed as unfit unless the
applicant‘s cardiac condition has been applicant‘s cardiac condition has been investigated applicant‘s cardiac condition has been investigated
investigated and evaluated in accordance with and evaluated in accordance with best medical and evaluated in accordance with best medical
best medical practice and is assessed not likely to practice and is assessed not likely to interfere with practice and is assessed not likely to interfere with
interfere with the safe exercise of the applicant‘s the safe exercise of the applicant‘s licence or the safe exercise of the applicant‘s licence and
licence or rating privileges. rating privileges. rating privileges.
C1.5.2An applicant with an abnormal cardiac C2.5.2An applicant with an abnormal cardiac C3.5.2An applicant with an abnormal cardiac
rhythm shall be assessed as unfit unless the rhythm shall be assessed as unfit unless the cardiac rhythm shall be assessed as unfit unless the cardiac
cardiac arrhythmia has been investigated and arrhythmia has been investigated and evaluated in arrhythmia has been investigated and evaluated in
evaluated in accordance with best medical accordance with best medical practice and is accordance with best medical practice and is
practice and is assessed not likely to interfere assessed not likely to interfere with the safe assessed not likely to interfere with the safe
with the safe exercise of the applicant‘s licence or exercise of the applicant‘s licence or rating exercise of the applicant‘s licence and rating
rating privileges. privileges. privileges.
Note. — Guidance on cardiovascular evaluation is Note. — Guidance on cardiovascular evaluation is Note. — Guidance on cardiovascular evaluation is
contained in the ICAO Manual of Civil Aviation contained in the ICAO Manual of Civil Aviation contained in the ICAO Manual of Civil Aviation
Medicine (Doc 8984). Medicine (Doc 8984). Medicine (Doc 8984).
C1.5.3Electrocardiography shall form part of the

C2.5.3Electrocardiography shall form part of the C3.5.3Electrocardiography shall form part of the
heart examination for the first issue of a Medical
heart examination for the first issue of a Medical heart examination for the first issue of a Medical
Assessment.
Assessment Assessment.
C1.5.4Electrocardiographyshall be included in re-
C2.5.4Electrocardiography shall be included in re- C3.5.4Electrocardiography shall be included in re-
examinations of applicants over the age of 40 no
examinations of applicants after the age of 40 no examinations of applicants after the age of 40 no
less frequently than annually
less frequently than every two years. less frequently than every two years.
C1.5.5 Electrocardiography should be included in Note 1. — The purpose of routine
5th Edition
re-examinations of applicants between the ages of C2.5.5Electrocardiography shall form part of the electrocardiography is case finding. It does not
30 and 40 no less frequently than every two years heart examination for the first issue of a Medical provide sufficient evidence, in isolation, to justify
Assessment after the age of 40. an ‗unfit‘ medical assessment. The results of further
Note 1. — The purpose of routine
cardiovascular examination and / or investigation
electrocardiography is case finding. It does not Note 1. — The purpose of routine
provide sufficient evidence, in isolation, to justify should be considered before any Medical
electrocardiography is case finding. It does not
an ‗unfit‘ medical assessment. The results of
Assessment decision is based on an abnormal
further cardiovascular examination and / or provide sufficient evidence, in isolation, to justify
routine electrocardiography result.
investigation should be considered before any an ‗unfit‘ medical assessment. The results of further
Medical Assessment decision is based on an cardiovascular examination and / or investigation Note 2.— Guidance on resting and exercise should be
abnormal routine electrocardiography result. considered before any Medical electrocardiography is contained in the ICAO Assessment decision is
based on an abnormal Manual of Civil Aviation Medicine (Doc 8984). routine electrocardiography
Note 2. — Guidance on resting and exercise
result.
electro-cardiography is contained in the ICAO
Manual of Civil Aviation Medicine (Doc 8984). Note 2. — Guidance on resting and exercise
electrocardiography is contained in the ICAO
Manual of Civil Aviation Medicine (Doc 8984).
C1.5.6 The systolic and diastolic blood pressures
shall be within normal limits. C3.5.6The systolic and diastolic blood pressures
C2.5.6The systolic and diastolic blood pressures shall be within normal limits.
C1.5.7 The use of drugs for control of high blood shall be within normal limits.
pressure shall be disqualifying except for those C3.5.7The use of drugs for control of high blood
drugs, the use of which is compatible with the C2.5.7The use of drugs for control of high blood pressure shall bedisqualifyingexcept for those
safe exercise of the applicant‘s licence and rating pressure shall be disqualifying except for those drugs, the use of which is compatible with the safe
privileges. drugs, the use of which is compatible with the safe exercise of the applicant‘s licence privileges.
exercise of the applicant‘s licence and rating
Note. — Guidance on the subject is contained in Note. — Guidance on this subject is contained in
the ICAO Manual of Civil Aviation Medicine privileges.
(Doc 8984). the ICAO Manual of Civil Aviation Medicine
C1.5.8There shall be no significant functional or Note. — Guidance on the subject is contained in the
structural abnormality of the circulatory system. (Doc 8984).
ICAO Manual of Civil Aviation Medicine (Doc
8984). C3.5.8There shall be no significant functional or
C2.5.8 There will be no significant functional or structural abnormality of the circulatory system.
structural abnormality of the circulatory system.
5th Edition
Respiratory Respiratory Respiratory

C1.6 There shall be no acute disability of the C2.6 There shall be no disability of the lungs or C3.6 There shall be no disability of the lungs or
lungs or any active disease of the structures of the any active disease of the structures of the lungs, any active disease of the structures of the lungs,
lungs, mediastinum or pleurae likely to result in mediastinum or pleura likely to result in mediastinum or pleurae likely to result in
incapacitating symptoms during normal or incapacitating symptoms during normal or incapacitating symptoms.
emergency operations. emergency operations.
C1.6.1 Chest radiography shall form part of the
initial examination only. It may be otherwise C2.6.1Chest radiography shall form part of the C3.6.1Chest radiography shall form part of the
advised when asymptomatic pulmonary disease initial examination only. It may be otherwise initial examination only. It may be otherwise
can be expected. advised when asymptomatic pulmonary disease advised when asymptomatic pulmonary disease
can be expected. can be expected.
C1.6.2 Applicants with chronic obstructive C3.6.2 Applicants with chronic obstructive
pulmonary disease shall be assessed as unfit C2.6.2 Applicants with chronic obstructive pulmonary disease shall be assessed as unfit unless
unless the applicant‘s condition has been pulmonary disease shall be assessed as unfit unless the applicant‘s condition has been investigated and
investigated and evaluated in accordance with the applicant‘s condition has been investigated and evaluated in accordance with best medical practice
best medical practice and is assessed not likely to evaluated in accordance with best medical practice and is assessed not likely to interfere with the safe
interfere with the safe exercise of the applicant‘s and is assessed not likely to interfere with the safe exercise of the applicant‘s licence or rating
licence or rating privileges. exercise of the applicant‘s licence or rating privileges.
privileges.
C1.6.3 Applicants with asthma causing significant C3.6.3 Applicants with asthma causing significant
symptoms or likely to cause incapacitating C2.6.3 Applicants with asthma causing significant symptoms or likely to cause incapacitating
symptoms during normal or emergency operations symptoms or likely to cause incapacitating symptoms shall be assessed as unfit.
shall be assessed as unfit. symptoms during normal or emergency operations
shall be assessed as unfit.
C1.6.4The use of drugs for control of asthma will C3.6.4The use of drugs for control of asthma shall
be disqualifying except for those drugs, the use of C2.6.4The use of drugs for control of asthma will be disqualifying except for those drugs, the use of
which is compatible with the safe exercise of the be disqualifying except for those drugs, the use of which is compatible with the safe exercise of the
applicant‘s licence and rating privileges. which is compatible with the safe exercise of the applicant‘s licence and rating privileges.
applicant‘s licence and rating privileges.
Note. — Guidance on hazards of medication and Note. — Guidance on hazards of medications is
drugs is contained in the ICAO Manual of Civil Note. — Guidance on hazards of medication and contained in the ICAO Manual of Civil Aviation
Aviation Medicine (Doc 8984). drugs is contained in the ICAO Manual of Civil Medicine (Doc 8984).
Aviation Medicine (Doc 8984).
C2.6.5 Applicants with active pulmonary

C1.6.5 Applicants with active pulmonary C3.6.5 Applicants with active pulmonary
tuberculosis shall be assessed as unfit.
tuberculosis shall be assessed as unfit. tuberculosis will be assessed as unfit.
C2.6.6Applicants with quiescent or healed lesions,
C1.6.6Applicants with quiescent or healed lesions C3.6.6Applicants with quiescent or healed lesions,
5th Edition
which are known to be tuberculous, or are known to be tuberculous or presumably known to be tuberculous or presumably
presumably tuberculous in origin, may be tuberculous in origin, may be assessed as fit. tuberculous in origin, may be assessed as fit.
assessed as fit.
Note 1.— Guidance on assessment of respiratory Note 1. –– Guidance on assessment of respiratory
Note 1.— Guidance on assessment of respiratory diseases is contained in the ICAO Manual of Civil
diseases is contained in the ICAO Manual of Civil
diseases is contained in the ICAO Manual of Civil Aviation Medicine (Doc 8984).
Note 2. –– Guidance on hazards of medication and
Note 2.— Guidance on hazards of medications and drugs is contained in the ICAO Manual of Civil Note 2. –– Guidance on hazards of medication and
drugs is contained in the ICAO Manual of Civil Aviation Medicine (Doc 8984). drugs is contained in the ICAO Manual of Civil
Aviation Medicine (Doc 8984). Aviation Medicine (Doc 8984).

5th Edition
Gastrointestinal Gastrointestinal Gastrointestinal

C1.7 Applicants with significant impairment of C2.7 Applicants with significant impairment of C3.7 Applicants with significant impairment of
function of the gastrointestinal tract or its adnexa function of the gastrointestinal tract or its adnexa function of the gastrointestinal tract or its adnexa
shall be assessed as unfit. shall be assessed as unfit. shall be assessed as unfit.
C1.7.1 Applicants shall be completely free from C2.7.1 Applicants shall be completely free from C3.7.1 Reserved
those hernias that might give rise to incapacitating those hernias that might give rise to incapacitating
symptoms. symptoms. C3.7.2 Applicants with sequelae of disease of or
C2.7.2 Applicants with sequelaeof disease of or surgical intervention on any part of the digestive
C1.7.2 Applicants with sequelae of disease of, surgical intervention on any part of the digestive tract or its adnexa, likely to cause incapacitation, in
or surgical intervention on, any part of the tract or its adnexa, likely to cause incapacitation in particular any obstructions due to stricture or
digestive tract or its adnexa, likely to cause flight, in particular any obstruction due to stricture compression, shall be assessed as unfit.
incapacitation in flight, in particular any or compression, shall be assessed as unfit.
obstruction due to stricture or compression, will C3.7.3 An applicant who has undergone a major
be assessed as unfit. C2.7.3 An applicant who has undergone a major surgical operation on the biliary passages or the
surgical operation on the biliary passages or the digestive tract or its adnexa, with a total or partial
C1.7.3 An applicant who has undergone a major digestive tract or its adnexa with a total or partial excision or a diversion of any of these organs
surgical operation on the biliary passages or the excision or a diversion of any of these organs should be assessed as unfit until such time as the
digestive tract or its adnexa with a total or partial should be assessed as unfit until such time as the medical assessor, having access to the details of
excision or a diversion of any of these organs medical assessor, having access to the details of the operation concerned, considers that the effects
should be assessed as unfit until such time as the the operation concerned, considers that the effects of the operation are not likely to cause
medical assessor, having access to the details of of the operation are not likely to cause incapacitation.
the operation concerned, considers that the effects incapacitation in flight.
of the operation are not likely to cause
incapacitation in flight.

5th Edition
Metabolic, nutritional, and Metabolic, nutritional, and Metabolic, nutritional, and

endocrine endocrine endocrine
C1.8 Applicants with metabolic, nutritional or C2.8 Applicants with metabolic, nutritional or C3.8 Applicants with metabolic, nutritional or
endocrine disorders that are likely to interfere endocrine disorders that are likely to interfere with endocrine disorders that are likely to interfere with
with the safe exercise of their licence and rating the safe exercise of their licence and rating the safe exercise of their licence and rating
privileges shall be assessed as unfit. privileges shall be assessed as unfit. privileges shall be assessed as unfit.
C1.8.1 Applicants with insulin-treated diabetes C2.8.1 Applicants with insulin-treated diabetes C3.8.1 Applicants with insulin-treated diabetes
mellitus shall be assessed as unfit. mellitus shall be assessed as unfit. mellitus shall be assessed as unfit.
Note. — Guidance on assessment of insulin treated Note. — Guidance on assessment of insulin treated Note. — Guidance on assessment of insulin treated
diabetic applicants under the provisions of C1.8.1 diabetic applicants under the provisions of C2.8.1 is diabetic applicants under the provisions of C2.8.1 is
is contained in the ICAO Manual of Civil Aviation contained in the ICAO Manual of Civil Aviation contained in the ICAO Manual of Civil Aviation
Medicine (Doc 8984). Medicine (Doc 8984). Medicine (Doc 8984).
C1.8.2Applicants with non-insulin-treated
diabetes mellitus shall be assessed as unfit unless
C2.8.2Applicants with non-insulin-treated diabetes C3.82Applicants with non-insulin-treated diabetes
the condition is shown to be satisfactorily
mellitus shall be assessed as unfit unless the shall be assessed as unfit unless the condition is
controlled by diet alone or by diet combined with
condition is shown to be satisfactorily controlled shown to be satisfactorily controlled by diet alone
oral anti-diabetic medication, the use of which is
by diet alone or by diet combined with oral anti- or by diet combined with oral anti-diabetic
compatible with the safe exercise of the
diabetic medication, the use of which is medication, the use of which is compatible with
applicant‘s licence and rating privileges.
compatible with the safe exercise of the applicant‘s the safe exercise of the applicant‘s licence and
Note. — Guidance on assessment of diabetic licence and rating privileges. rating privileges.
applicants is contained in the ICAO Manual of Note. — Guidance on assessment of diabetic Note. — Guidance on assessment of diabetic
Civil Aviation Medicine (Doc 8984). applicants is contained in the ICAO Manual of Civil applicants is contained in the ICAO Manual of Civil
Aviation Medicine (Doc 8984). Aviation Medicine (Doc 8984).
Blood and lymphatic Blood and lymphatic Blood and lymphatic
C1.9Applicants with diseases of the blood and/or C2.9 Applicants with diseases of the blood C3.9 Applicants with diseases of the blood
the lymphatic system shall be assessed as unfit and/or the lymphatic system shall be assessed as and/or the lymphatic system shall be assessed as
unless adequately investigated and their condition unfit unless adequately investigated and their unfit, unless adequately investigated and their
found unlikely to interfere with the safe exercise condition found unlikely to interfere with the safe condition found unlikely to interfere with the safe
of their licence and rating privileges. exercise of their licence and rating privileges. exercise of their licence and rating privileges.
Note.—Sickle cell trait or other Note. — Sickle cell trait and other Note. — Sickle cell trait and other
haemoglobinopathic traits are usually compatible haemoglobinopathic traits are usually compatible haemoglobinopathic traits are usually compatible
with a fit assessment. with a fit assessment. with a fit assessment.

5th Edition
Renal and Genito-urinary Renal and Genito-urinary Renal and Genito-urinary

C1.10 Applicants with renal or genito-urinary C2.10 Applicants with renal or genito-urinary C3.10 Applicants with renal or genito-urinary
disease shall be assessed as unfit, unless disease shall be assessed as unfit unless adequately disease shall be assessed as unfit unless adequately
adequately investigated and their condition found investigated and their condition found unlikely to investigated and their condition found unlikely to
unlikely to interfere with the safe exercise of their interfere with the safe exercise of their licence and interfere with the safe exercise of their licence and
licence and rating privileges. rating privileges. rating privileges.
C1.10.1Urine examination shall form part of the C2.10.1Urine examination shall form part of the C3.10.1Urine examination will form part of the
medical examination and abnormalities shall be medical examination and abnormalities will be medical examination and abnormalities will be
adequately investigated. adequately investigated. adequately investigated.
Note. — Guidance on urine examination and Note. — Guidance on urine examination and Note. — Guidance on urine examination and
evaluation of abnormalities is contained in the evaluation of abnormalities is contained in the evaluation of abnormalities is contained in the
ICAO Manual of Civil Aviation Medicine (Doc ICAO Manual of Civil Aviation Medicine (Doc ICAO Manual of Civil Aviation Medicine (Doc
8984). 8984). 8984).
C1.10.2 Applicants with sequalae of disease of or C2.10.2 Applicants with sequelae of disease of, or C3.10.2 Applicants with sequelae of disease of, or
surgical procedures on the kidneys or the genito- surgical procedures on, the kidneys or the genito- surgical procedures on the kidneys or the genito-
urinary tract, in particular obstructions due to urinary tract, in particular obstructions due to urinary tract, in particular obstructions due to
stricture or compression, will be assessed as unfit stricture or compression, shall be assessed as unfit stricture or compression, shall be assessed as unfit
unless the applicant‘s condition has been unless the applicant‘s condition has been unless the applicant‘s condition has been
investigated and evaluated in accordance with investigated and evaluated in accordance with best investigated and evaluated in accordance with best
best medical practice and is assessed not likely to medical practice and is assessed not likely to medical practice and is assessed not likely to
interfere with the safe exercise of the applicant‘s interfere with the safe exercise of the applicant‘s interfere with the safe exercise of the applicant‘s
licence or rating privileges. licence or rating privileges. licence or rating privileges.
C1.10.3Applicants who have undergone C2.10.3Applicants who have undergone C3.10.3Applicants who have undergone
nephrectomy will be assessed as unfit unless the nephrectomy shall be assessed as unfit unless the nephrectomy shall be assessed as unfit unless the
condition is well compensated. condition is well compensated. condition is well compensated.

5th Edition
Human Human Immunodeficiency Human Immunodeficiency

Immunodeficiency Virus Virus Virus
C1.11 Applicants who are seropositive for C2.11 Applicants who are seropositive for C3.11 Applicants who are seropositive for
human immunodeficiency virus (HIV) shall be human immunodeficiency virus (HIV) shall be human immunodeficiency virus (HIV) shall be
assessed as unfit unless full investigation provides assessed as unfit unless full investigation provides assessed as unfit unless full investigation provides
no evidence of HIV-associated diseases likely to no evidence of HIV-associated diseases likely to no evidence of HIV-associated diseases likely to
give rise to incapacitating symptoms. give rise to incapacitating symptoms. give rise to incapacitating symptoms.
Note 1. — Early diagnosis and active management Note 1. — Early diagnosis and active management Note 1. — Early diagnosis and active management
of HIV disease with antiretroviral therapy reduces of HIV disease with antiretroviral therapy reduces of HIV disease with antiretroviral therapy reduces
morbidity and improves prognosis and thus morbidity and improves prognosis and thus morbidity and improves prognosis and thus
increases the likelihood of a fit assessment. increases the likelihood of a fit assessment. increases the likelihood of a fit assessment.
Note 2. — Guidance on the assessment of Note 2. — Guidance on the assessment of applicants Note 2. — Guidance on the assessment of applicants
applicants who are seropositive for human who are seropositive for human immunodeficiency who are seropositive for human immunodeficiency
immunodeficiency virus (HIV) is contained in the virus (HIV) is contained in the ICAO Manual of virus (HIV) is contained in the ICAO Manual of
ICAO Manual of Civil Aviation Medicine Civil Aviation Medicine (Doc 8984). Civil Aviation Medicine (Doc 8984).
(Doc 8984).
Reproductive Reproductive Reproductive
C1.12Applicants with reproductive system C2.12Applicants with reproductive system C3.12Applicants with reproductive system
disorders that are likely to interfere with the safe disorders that are likely to interfere with the safe disorders that are likely to interfere with the safe
exercise of their licence and rating privileges shall exercise of their licence and rating privileges shall exercise of their licence and rating privileges shall
be assessed as unfit. be assessed as unfit. be assessed as unfit.
C1.12.1 Applicants who are pregnant shall be C2.12.1 Applicants who are pregnant shall be C3.12.1 Applicants who are pregnant shall be
assessed as unfit unless obstetrical evaluation and assessed as unfit unless obstetrical evaluation and assessed as unfit unless obstetrical evaluation and
continued medical supervision indicate a low-risk continued medical supervision indicate a low-risk continued medical supervision indicate a low-risk
uncomplicated pregnancy. uncomplicated pregnancy. uncomplicated pregnancy.
C1.12.2 Reserved C2.12.2 Reserved C3.12.2During the gestational period, precautions

should be taken for the timely relief of an air
C1.12.3 Applicants with a low-risk C2.12.3Applicants with a low-risk uncomplicated traffic controller in the event of early onset of
uncomplicated pregnancy shall be evaluated and pregnancy shall be evaluated and supervised, and labour or other complications.
supervised, and an assessment as fit should be an assessment as fit should be limited to the period
limited to the period from the end of the 12th from the end of the 12th week until the end of the
week until the end of the 26th week of gestation. 26th week of gestation. C3.12.3. Applicants with a low-risk uncomplicated
pregnancy shall be evaluated and supervised, and
C1.12.4 Following confinement or termination of an assessment as fit should be limited to the period

5th Edition
pregnancy, the applicant shall not be permitted to C2.12.4 Following confinement or termination of from the end of the 12th week until the end of the
exercise the privileges of her licence until she has pregnancy, the applicant shall not be permitted to 26th week of gestation.
undergone re-evaluation in accordance with best exercise the privileges of her licence until she has
medical practice and it has been determined that undergone re-evaluation in accordance with best C3.12.4Following confinement or termination of
she is able to safely exercise the privileges of her medical practice and it has been determined that pregnancy the applicant will not be permitted to
licence and ratings. she is able to safely exercise the privileges of her exercise the privileges of her licence until she has
licence and ratings. undergone re-evaluation in accordance with best
medical practice and it has been determined that
she is able to safely exercise the privileges of her
licence and ratings.

5th Edition
Musculoskeletal Musculoskeletal Musculoskeletal

abnormality of the bones, joints, muscles, tendons abnormality of the bones, joints, muscles, tendons abnormality of the bones, joints, muscles, tendons
or related structures which is likely to interfere or related structures which is likely to interfere or related structures which is likely to interfere
with the safe exercise of the applicant‘s licence with the safe exercise of the applicant‘s licence with the safe exercise of the applicant‘s licence
and rating privileges. and rating privileges. and rating privileges.
Note. — Any sequelae after lesions affecting the Note. — Any sequelae after lesions affecting the Note. — Any sequelae after lesions affecting the
bones, joints, muscles or tendons, and certain bones, joints, muscles or tendons, and certain bones, joints, muscles or tendons, and certain
anatomical defects will normally require functional anatomical defects will normally require functional anatomical defects will normally require functional
assessment to determine fitness. assessment to determine fitness. assessment to determine fitness.
Ear, nose, and throat Ear, nose, and throat Ear, nose, and throat
abnormality or disease of the ear or related abnormality or disease of the ear or related abnormality or disease of the ear or related
structures which is likely to interfere with the safe structures which is likely to interfere with the safe structures which is likely to interfere with the safe
exercise of the applicant‘s licence and rating exercise of the applicant‘s licence and rating exercise of the applicant‘s licence and rating
privileges. privileges. privileges.
C1.14.1There will be: C2.14.1 There shall be: C3.14.1 Reserved

a) no disturbance of vestibular function; a) no disturbance of the vestibular function;
b) no significant dysfunction of the b) no significant dysfunction of the Eustachian C3.14.2 Reserved
Eustachian tubes; and tubes; and
c) no unhealed perforation of the tympanic c)no unhealed perforation of the tympanic C3.14.3 There shall be no malformation or any
membranes. membranes. disease of the nose, buccal cavity or upper
respiratory tract which is likely to interfere with
C2.14.2 A single dry perforation of the tympanic the safe exercise of the applicant‘s licence and
C1.14.2 A single dry perforation of the tympanic membrane need not render the applicant unfit. rating privileges.
membrane need not render the applicant unfit.
Note. —Guidance on testing of the vestibular
C3.14.4 Applicants with stuttering or other speech
function is contained in the ICAO Manual of Civil
defects sufficiently severe to cause impairment of
Note. — Guidance on testing of the vestibular Aviation Medicine (Doc 8984).
speech communication shall be assessed as unfit.
function is contained in ICAO Manual of Civil

5th Edition
C1.14.3 There shall be: C2.14.3 There shall be:

a) no nasal obstruction; and a) no nasal obstruction; and
b) no malformation nor any disease of the b) no malformation nor any disease of the .
buccal cavity or upper respiratory tract;
which is likely to interfere with the safe exercise
of the applicant‘s licence and rating privileges.
C1.14.4 Applicants with stuttering or other

speech defects sufficiently severe to cause
impairment of speech communication shall be
assessed as unfit. buccal cavity or upper respiratory tract;
which is likely to interfere with the safe exercise
of the applicant‘s licence and rating privileges.
C2.14.4 Applicants with stuttering and other

speech defects sufficiently severe to cause
impairment of speech communication shall be
assessed as unfit.

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Vision Vision Vision

C1.15 Visual requirements- The medical C2.15Visual requirements- The medical C3.15 Visual requirements- The medical
examination shall be based on the following examination shall be based on the following examination shall be based on the following
requirements. requirements. requirements.
C1.15.1 The function of the eyes and their adnexa C2.15.1 The function of the eyes and their adnexa C3.15.1 The function of the eyes and their adnexa
shall be normal. There shall be no active shall be normal. There shall be no active shall be normal. There shall be no active
pathological condition, acute or chronic, or any pathological condition, acute or chronic, or any pathological condition, acute or chronic, or any
sequelae of surgery or trauma of the eyes or their sequelae of surgery or trauma of the eyes or their sequelae of surgery or trauma of the eyes or their
adnexa likely to reduce proper visual function to adnexa likely to reduce proper visual function to adnexa likely to reduce proper visual function to
an extent that would interfere with the safe an extent that would interfere with the safe an extent that would interfere with the safe
exercise of the applicant‘s licence and rating exercise of the applicant‘s licence and rating exercise of the applicant‘s licence and rating
privileges. privileges. privileges.
C1.15.2 Distant visual acuity with or without C2.15.2 Distant visual acuity with or without C3.15.2Distant visual acuity with or without
correction shall be 6/9 or better in each eye correction shall be 6/12 or better in each eye correction shall be 6/9 or better in each eye
separately, and binocular visual acuity will be 6/6 separately, and binocular visual acuity shall be 6/9 separately, and binocular visual acuity will be 6/6
or better. No limits apply to uncorrected visual or better. No limits apply to uncorrected visual or better. No limits apply to uncorrected visual
acuity. Where this standard of visual acuity can acuity. Where this standard of visual acuity can be acuity. Where this standard of visual acuity can be
be obtained only with correcting lenses, the obtained only with correcting lenses, the applicant obtained only with correcting lenses, the applicant
applicant may be assessed as fit provided that: may be assessed as fit provided that: may be assessed as fit provided that:
a) such correcting lenses are worn during the a) such correcting lenses are worn during the a) such correcting lenses are worn during the
exercise of the privileges of the licence or exercise of the privileges of the licence or exercise of the privileges of the licence or
rating applied for or held; and rating applied for or held; and rating applied for or held; and
b) an additional pair of suitable correcting b) an additional pair of suitable correcting b) an additional pair of suitable correcting
spectacles is kept readily available during spectacles is kept readily available during spectacles is kept readily available during
the exercise of the privileges of the the exercise of the privileges of the the exercise of the privileges of the
applicant‘s licence. applicant‘s licence. applicant‘s licence.
Note 1.—C1.15.2 b) is the subject of Standards in Note. — An applicant accepted as meeting these Note. — An applicant accepted as meeting these
Annex 6, Part I. provisions is deemed to continue to do so unless provisions is deemed to continue to do so unless
there is reason to suspect otherwise, in which case there is reason to suspect otherwise, in which case
Note 2. — An applicant accepted as meeting these an ophthalmic report is required at the discretion of an ophthalmic report is required at the discretion of
provisions is deemed to continue to do so unless the medical assessor. Both uncorrected and the medical assessor. Both uncorrected and
there is reason to suspect otherwise, in which case
corrected visual acuity are normally measured and corrected visual acuity are normally measured and
an ophthalmic report is required at the discretion of
recorded at each re-examination. Conditions which recorded at each re-examination. Conditions which
the medical assessor. Both uncorrected and
indicate a need to obtain an ophthalmic report indicate a need to obtain an ophthalmic report
corrected visual acuity are normally measured and
5th Edition
recorded at each re-examination. Conditions which include: a substantial decrease in the uncorrected include: a substantial decrease in the uncorrected
indicate a need to obtain an ophthalmic report visual acuity, any decrease in best corrected visual visual acuity, any decrease in best corrected visual
include: a substantial decrease in the uncorrected acuity, and the occurrence of eye disease, eye injury acuity, and the occurrence of eye disease, eye injury
visual acuity, any decrease in best corrected visual or eye surgery. or eye surgery.
acuity, and the occurrence of eye disease, eye
injury or eye surgery.
C3.15.3 Applicants may use contact lenses to meet
this requirement provided that:
C2.15.3 Applicants may use contact lenses to meet
C1.15.3 Applicants may use contact lenses to a) the lenses are monofocal and non-tinted;
this requirement provided that:
meet this requirement provided that: b) the lenses are well tolerated; and
a) the lenses are monofocal and non-tinted;
a) the lenses are monofocal and non-tinted; c) a pair of suitable correcting spectacles is
b) the lenses are well tolerated; and
b) the lenses are well tolerated; and kept readily available during the exercise of
c) a pair of suitable correcting spectacles is
c) a pair of suitable correcting spectacles is the licence privileges.
kept readily available during the exercise of
kept readily available during the exercise
the licence privileges.
of the licence privileges.
Note.— Applicants who use contact lenses may not Note.— Applicants who use contact lenses may not
Note.— Applicants who use contact lenses may not need to have their uncorrected visual acuity need to have their uncorrected visual acuity
need to have their uncorrected visual acuity measured at each re-examination provided the
measured at each re-examination provided the
measured at each re-examination provided the history of their contact lens prescription is known.
history of their contact lens prescription is known.
history of their contact lens prescription is known.
C3.15.4 Applicants with a large refractive error
C2.15.4 Applicants with a large refractive error shall use contact lenses or high-index spectacle
C1.15.4 Applicants with a large refractive error
shall use contact lenses or high-index spectacle lenses.
shall use contact lenses or high-index spectacle
lenses.
lenses. Note. — If spectacles are used, high-index lenses are
Note. — If spectacles are used, high-index lenses are needed to minimize peripheral field distortion.
Note. — If spectacles are used, high-index lenses
needed to minimize peripheral field distortion.
are needed to minimize peripheral field distortion.
C2.15.5Applicants whose uncorrected distant C3.15.5 Applicants whose uncorrected distant
C1.15.5Applicants whose uncorrected distant
visual acuity in either eye is worse than 6/60 visual acuity in either eye is worse than 6/60 shall
visual acuity in either eye is worse than 6/60 shall should be required to provide a full ophthalmic be required to provide a full ophthalmic report
be required to provide a full ophthalmic report report prior to initial Medical Assessment and prior to initial Medical Assessment and every five
prior to initial Medical Assessment and every five every five years thereafter. years thereafter.
years thereafter.
Note 1.— The purpose of the required ophthalmic Note 1.— The purpose of the required ophthalmic
Note 1.— The purpose of the required ophthalmic examination is (1) to ascertain normal visual examination is (1) to ascertain normal vision
examination is (1) to ascertain normal visual performance, and (2) to identify any significant performance, and (2) to identify any significant
performance, and (2) to identify any significant pathology. pathology.
pathology.
Note 2.— Guidance on the assessment of monocular Note 2.— Guidance on the assessment of monocular
Note 2.— Guidance on the assessment of
5th Edition
monocular applicants under the provisions of applicants under the provisions of C2.15.10 is applicants under the provisions of C3.15.10 is
C1.15.10 is contained in the ICAO Manual of contained in the ICAO Manual of Civil Aviation contained in the ICAO Manual of Civil Aviation
Civil Aviation Medicine (Doc 8984). Medicine (Doc 8984). Medicine (Doc 8984).
C1.15.6 Applicants who have undergone surgery C3.15.6 Applicants who have undergone surgery
C2.15.6 Applicants who have undergone surgery
affecting the refractive status of the eye shall be affecting the refractive status of the eye shall be
affecting the refractive status of the eye shall be
assessed as unfit unless they are free from those assessed as unfit unless they are free from those
assessed as unfit unless they are free from those
sequelae which are likely to interfere with the safe sequelae which are likely to interfere with the safe
sequelae which are likely to interfere with the safe
exercise of their licence and rating privileges. exercise of their licence and rating privileges.
exercise of their licence and rating privileges.
C1.15.7 The applicant shall have the ability to C3.15.7 The applicant shall have the ability to
C2.15.7 The applicant shall have the ability to
read, while wearing the correcting lenses, if any, read, while wearing the correcting lenses, if any,
read, while wearing the correcting lenses, if any,
the N5 chart or its equivalent at a distance the N5 chart or its equivalent at a distance selected
the N5 chart or its equivalent at a distance selected
selected by that applicant in the range of 30 to 50 by that applicant in the range of 30 to 50 cm and
by that applicant in the range of 30 to 50 cm. If this
cm and the ability to read the N14 chart or its the ability to read the N14 chart or its equivalent at
requirement is met only by the use of near
equivalent at a distance of 100 cm. If this a distance of 100 cm. If this requirement is met
correction, the applicant may be assessed as fit
requirement is met only by the use of near only by the use of near correction, the applicant
provided that this near correction is added to the
correction, the applicant may be assessed as fit may be assessed as fit provided that this near
spectacle correction already prescribed; if no such
provided that this near correction is added to the correction is added to the spectacle correction
correction is prescribed, a pair of spectacles for
spectacle correction; if no such correction is already prescribed; if no such correction is
near use will be kept readily available during the
prescribed, a pair of spectacles for near use will prescribed, a pair of spectacles for near use will be
exercise of the privileges of the licence. When near
be kept readily available during the exercise of kept readily available during the exercise of the
correction is required, the applicant shall
the privileges of the licence. privileges of the licence. When near correction is
demonstrate that one pair of spectacles is sufficient
When near correction is required, the applicant required, the applicant shall demonstrate that one
to meet both distant and near visual requirements.
will demonstrate that one pair of spectacles is pair of spectacles is sufficient to meet both distant
sufficient to meet both distant and near visual and near visual requirements.
requirements.
Note 1. — N5 and N14 refer to the size of typeface
Note 1. — N5 and N14 refer to the size of typeface used. For further details, see the ICAO Manual of
used. For further details, see the ICAO Manual of Note 1. — N5 refers to the size of typeface used. Civil Aviation Medicine (Doc 8984).
Civil Aviation Medicine (Doc 8984). For further details, see the ICAO Manual of Civil
Aviation Medicine (Doc 8984). Note 2.— An applicant who needs near correction to
Note 2. — An applicant who needs near correction to meet the requirement will require ―look-over‖,
Note 2. — An applicant who needs near correction to
meet this requirement will require ―look-over‖, bifocal or perhaps multi-focal lenses in order to read
meet the requirement will require ―look-over‖,
bifocal or perhaps multifocal lenses in order to read radar screens, visual displays and written or printed
bifocal or perhaps multifocal lenses in order to read
the instruments and a chart or manual held in the material and also to make use of distant vision,
the instruments and a chart or manual held in the hand,
hand, and also to make use of distant vision, through the windows, without removing the lenses.
and also to make use of distant vision, through
through the windscreen, without removing the Single-vision near correction (full lenses of one
the windscreen, without removing the lenses.
lenses. Single-vision near correction (full lenses of power only, appropriate for reading) may be
Single-vision near correction (full lenses of
one power only, appropriate for reading) acceptable for certain air traffic control duties.
5th Edition
significantly reduces distant visual acuity and is one power only, appropriate for reading) However, it should be realized that single-vision
therefore not acceptable. significantly reduces distant visual acuity and is near correction significantly reduces distant visual
therefore not acceptable. acuity.
Note 3.— Whenever there is a requirement to obtain
or renew correcting lenses, an applicant is expected Note 3. — Whenever there is a requirement to obtain Note 3. — Whenever there is a requirement to obtain
to advise the refractionist of reading distances for or renew correcting lenses, an applicant is expected or renew correcting lenses, an applicant is expected
the visual flight deck tasks relevant to the types of to advise the refractionist of the reading distances to advise the refractionist of reading distances for
aircraft in which the applicant is likely to function. for the visual flight deck tasks relevant to the types the air traffic control duties the applicant is likely to
of aircraft in which the applicant is likely to perform.
function.
C1.15.8 When near correction is required in
accordance with this paragraph, a second pair of C3.15.8 When near correction is required in
near-correction spectacles shall be kept available C2.15.8 When near correction is required in accordance with this paragraph, a second pair of
for immediate use. accordance with this paragraph, a second pair of near-correction spectacles shall be kept available
near-correction spectacles shall be kept available for immediate use.
C1.15.9 The applicant shall be required to have for immediate use.
normal fields of vision. C3.15.9 The applicant shall be required to have
C2.15.9 The applicant shall be required to have normal fields of vision.
C1.15.10 The applicant shall be required to have normal fields of vision.
normal binocular function. C3.15.10 The applicant shall be required to have
C2.15.10 The applicant shall be required to have normal binocular function.
normal binocular function.
C3.15.11 Reduced stereopsis, abnormal
C1.15.11 Reduced stereopsis, abnormal C2.15.11 Reduced stereopsis, abnormal convergence not interfering with near vision, and
convergence not interfering with near vision, and convergence not interfering with near vision, and ocular misalignment where the fusional reserves
ocular misalignment where the fusional reserves ocular misalignment where the fusional reserves are sufficient to prevent asthenopia and diplopia
are sufficient to prevent asthenopia and diplopia are sufficient to prevent asthenopia and diplopia need not be disqualifying.
need not be disqualifying. need not be disqualifying.

5th Edition
Hearing Hearing Hearing

C1.17 Hearing requirements
C1.17.1 An Applicant who is unable to hear an C2.17 Hearing requirements C3.17 Hearing requirements
average conversational voice in a quiet room, C2.17.1An Applicant who is unable to hear an C3.17.1 An Applicant who is unable to hear an
using both ears, at a distance of 2 m from the average conversational voice in a quiet room, average conversational voice in a quiet room,
examiner and with the back turned to the using both ears, at a distance of 2 m from the using both ears, at a distance of 2 m from the
examiner, shall be assessed as unfit. examiner and with the back turned to the examiner and with the back turned to the
examiner, shall be assessed as unfit. examiner, shall be assessed as unfit.
C1.17.2 An applicant, when tested on a pure-tone
audiometer, shall not have a hearing loss, in either C2.17.2. An Applicant, when tested by pure-tone C1.17.2 An applicant, when tested on a pure-tone
ear separately, of more than 35 dB at any of the audiometry, shall not have a hearing loss, in either audiometer shall not have a hearing loss, in either
frequencies 500, 1 000 or 2 000 Hz, or more than ear separately, of more than 35 dB at any of the ear -separately, of more than 35 dB at any of the
50 dB at 3 000 Hz. frequencies 500, 1 000 or 2 000 Hz, or more than frequencies 500, 1 000 or 2 000 Hz, or more than
50 dB at 3 000 Hz. 50 dB at 3 000 Hz.
C1.17.3 An applicant who does not meet the
requirements should undergo further testing. C2.17.3 An applicant who does not meet the C3.17.3 An applicant who does not meet the
Tests include Speech receptor test (SRT) and requirements should undergo further testing. requirements should undergo further testing. Tests
Speech discrimination test (SDT). Tests include Speech receptor test (SRT) and include Speech receptor test (SRT) and Speech
Speech discrimination test (SDT). discrimination test (SDT).
C1.17.4An applicant with a hearing loss greater
than the above may be declared fit provided that C2.17.4 An applicant with a hearing loss greater C3.17.4An applicant with a hearing loss greater
the applicant has normal hearing performance than the above may be declared fit provided that than the above may be declared fit provided that
against a background noise that reproduces or the applicant has normal hearing performance the applicant has normal hearing performance
simulates the masking properties of flight deck against a background noise that reproduces or against a background noise that reproduces or
noise upon speech and beacon signals. simulates that experienced in a typical air traffic simulates that experienced in a typical air traffic
Note 1. — It is important that the background noise control working environment. control working environment.
be representative of the noise in the cockpit of the Note 1.— The frequency composition of the Note 1.— The frequency composition of the
type of aircraft for which the applicant‘s licence background noise is defined only to the extent that background noise is defined only to the extent that
and ratings are valid. the frequency range 600 to 4 800 Hz (speech the frequency range 600 to 4 800 Hz (speech
Note 2. — In the speech material for discrimination frequency range) is adequately represented. frequency range) is adequately represented.
testing, both aviation-relevant phrases and Note 2. — In the speech material for discrimination
phonetically balanced words are normally used. Note 2. — In the speech material for testing, both aviation-relevant phrases and
C1.17.5 Alternatively, a practical hearing test discrimination testing, both aviation-relevant phonetically balanced words are normally used.
conducted in flight in the cockpit of an aircraft of phrases and phonetically balanced words are
the type for which the applicant‘s licence and normally used. C3.17.5Alternatively, a practical hearing test
ratings are valid may be used. conducted in an air traffic control environment
representative of the one for which the applicant‘s

5th Edition
licence and ratings are valid may be used.
C1.16 Colour Perception Requirement C2.16 Colour Perception Requirement C3.16 Colour Perception Requirement
The applicant shall be tested for their ability to The applicant shall be tested for their ability to The applicant shall be tested for their ability to
correctly identify a series of pseudo-isochromatic correctly identify a series of pseudo-isochromatic correctly identify a series of pseudo-isochromatic
plates in day light or in artificial light of the same plates in day light or in artificial light of the same plates in day light or in artificial light of the same
colour temperature such as that provided by CIE colour temperature such as that provided by CIE colour temperature such as that provided by CIE
standard illuminant "C" or "D65" as specified by standard illuminant "C" or "D65" as specified by standard illuminant "C" or "D65" as specified by
International Commission of Illumination (CIE). International Commission of Illumination (CIE). International Commission of Illumination (CIE).
An applicant failing to obtain a satisfactory

An applicant failing to obtain a satisfactory An applicant failing to obtain a satisfactory score in such a test may nevertheless be
score in such a test may nevertheless be score in such a test may nevertheless be assessed as 'fit' provided the applicant is able
assessed as 'fit' provided the applicant is able assessed as 'fit' provided the applicant is able to readily and correctly identify 'aviation
to readily and correctly identify 'aviation to readily and correctly identify 'aviation colour lights' displayed by means of
colour lights' displayed by means of colour lights' displayed by means of recognized Colour Perception Lantern.
recognized Colour Perception Lantern. recognized Colour Perception Lantern.
C1.16.1 The applicant shall be required to C2.16.1 The applicant shall be required to C3.16.1 The applicant shall be required to
demonstrate an ability to perceive demonstrate an ability to perceive readily demonstrate an ability to perceive readily
readily those colours the perception of those colours the perception of which is those colours the perception of which is
which is necessary for the safe necessary for the safe performance of the necessary for the safe performance of the
performance of the duties. duties. duties.
Note. - Sunglasses worn during the exercise of the Note. - Sunglasses worn during the exercise of the
privileges of the licence should be of privileges of the licence should be of neutral grey Note. - Sunglasses worn during the exercise of the
neutral grey tint and shall be used only in tint and shall be used only in day light and shall privileges of the licence should be of neutral grey
day light and shall not be used in night not be used in night time. They shall neither be tint and shall be used only in day light and shall
time. They shall neither be polarizing polarizing nor polychromatic. not be used in night time. They shall neither be
nor polychromatic. polarizing nor polychromatic.

5th Edition
Appendix 1
FLIGHT SAFETY STANDARDS DEPARTMENT
TESTS REQUIREMENTS FOR MEDICAL EXAMINATION AND MEDICAL ASSESSMENT
Tests required Class I Class II Class III
Blood Examination
TC,DC, HB, TSH Initial Initial Initial
TC,DC,Hb,ESR,FBS&Lipid profile At 40 and every 5 years there after At 40 and every 5 years there after At 40 and every 5 years there after
TSH test Every 2yrs TSH test every 2yrs TSH Every 2 yrs
PSA,LFT,RFT,Uric Acid, Lipid At 40 onwards annually At 40 onwards annually At 40 onwards annually

profile,HBA1C
Urine Examination: Initial Initial Initial
Routine & Microscopic At 40 and every 5 years thereafter At 40 and every 5 years thereafter At 40 and every 5 years thereafter
Albumin & Sugar examination Each Medical Each Medical Each Medical
Ultrasound At 40 onwards annually At 40 onwards annually At 40 onwards annually
Electrocardiogram Initial Initial Initial
30 to 40 years: Every 2 years 30 to 40 years: Every 2 years 30 to 40 years: Every 2 years
Echocardiogram At 40 and every 5 years thereafter At 40 and every 5 years thereafter At 40 and every 5 years thereafter
Exercise Electrocardiogram(TMT ) At 40 and every year thereafter At 40 and every year thereafter At 40 and every 2 years thereafter
Coronary Calcium Score(If
borderline or mild ischemic changes
noted in TMT)
Chest X ray PA view Initial and every 5 years after 40 Initial and every 5 years after 40 Initial and every 5 years after 40
Audiogram in pure tone audiometer Initial Initial Initial
30 to 40 years : Every 5 years 30 to 50 years : Every 5 years 30 to 40 years : Every 5 years
After 40 : Every 2 years After 50 : Every 2 years After 40 : Every 2 years
 Applicant shall record regular medication consumed, duration of treatment, any significant medical event or aviation incident/accident in Statement Form.
 Additional tests and specialist opinion may be required if any significant medical condition or abnormality is detected that may cause a degree of functional
incapacity.
 Additional tests required for renewal with medical conditions:
o Hypertension, controlled on acceptable anti hypertensive drugs: Each medical examination Urine routine & microscopic, Blood for Urea,
- –
Creatinine& electrolytes; Every year Lipid profile and Electrocardiogram; Every 2 years Echocardiogram and Exercise ECG.
- -
o Diabetes mellitus, controlled with diet or acceptable anti-diabetic agent: Each medical examination- Blood sugar (F or R) and Glycosylated Hgb
(HbA1C); Every year Urine routine & microscopic and Lipid profile; Every 2 years Echocardiogram, Exercise ECG, Fundoscopic Examination,
– –
Urine for microalbumin.

o Coronary artery disease with or without intervention or operation, on acceptable medicines: Each medical examination year Electrocardiogram;
–
Every year Urine routine & microscopic, Lipid profile; Every year Echocardiogram and Exercise ECG. Every 5 years: Coronary Angiogram.
- -
Amdt. No- 02 CIVIL AVIATION AUTHORITY OF NEPAL Page 2 - 27

5th Edition
PART 3
GUIDELINES
ON
MEDICAL CONDITIONS
Rev. 00 CIVIL AVIATION AUTHORITY OF NEPAL Page 3 - 1

5th Edition
3.1. General
Before issuing a licence, initial or renewal, the applicant for a flight crew or air traffic
controller licence is medically examined. If the applicant passes the medical assessment of
the required Class as per the standards laid down in Medical Requirements, they will be
assessed as Medically Fit and recommended for the issue of the licence. If the applicant has
any finding or medical condition that does not clearly meet the medical requirements, they
fail the medical assessment and so will not be recommended for issue of licence.
The main objective of the medical examination and assessment process is to ensure that the
applicant or holder is:
1. physically and mentally capable of performing their flying duties in a safe manner.
This includes having full use of their faculties i.e. visual ability, hearing, colour
perception, balance, muscle sense, etc. and their ability to evaluate flight conditions
and to decide a safe course of action;
2. free of disease or any condition which may suddenly render them incapable of
performing their duties in a safe manner during flight (acute incapacitation) or
imperceptibly lead them to commit or omit actions that may jeopardize safety of the
flight (subtle incapacitation); and
3. free of disease which may slowly but within the period of validity of the licence
reduce their capacity for performing their duties at an acceptable level.
In cases with borderline or doubtful findings, or persistence of residual pathology or reduced

function or disability after recovery from illness or operation or accident or any other medical
event, the applicant may be considered for recertification. Such cases are usually referred for
accredited medical opinion by Aviation Specialist Consultants and may include further evaluation as
well as tests as felt necessary.
. All medical reports from their treating physician should be provided, when applicable. If
such specialists are of the opinion that the findings or residual pathology or reduced function
or disability is not likely to interfere with the safe operation of the aircraft or with the safe
performance of the applicant‘s duties, they may be assessed as medically fit. In such an
evaluation the applicant‘s relevant ability, skill and experience, and operational conditions are
also given due consideration. On receiving such accredited medical opinion, the applicant
may be recommended for issue or renewal of the licence by CAMA. In such cases, a
'limitation' or 'restriction' is usually endorsed for the sake of flight safety. Restrictions may be
removed after the medical situation changes. They are, in the case of flight crew, as given
below:
'Fit to fly as co-pilot only'

'Fit to fly only with suitably qualified co-pilot'
'Fit to fly only with Senior Co-pilot'
'Fit to fly only with another Captain'
'Fit to fly only with a safety pilot with dual controls in single pilot
aircraft' 'Fit to fly solo in cargo or non-revenue passenger flights only'
There may be other endorsements, such as use of appliances e.g. glasses, frequent
assessments, additional tests, specialist reports, accredited medical opinion, practical flight
tests, etc. when the safe performance of the licence holder's duties is dependent upon
compliance with such endorsements.
5th Edition
In case of Class II and Class III medical assessments, especially for private and recreational
flying, less stringent medical standards may be acceptable due to the nature of their work and
safety concern, though the principle of evaluation will be the same.
If the applicant is to be on medications, those should be from the approved list or have prior
approval from CAMA/DME/SME.
Continuous supervision and follow-up will be important in some cases. It should be the
responsibility of the Airline doctor, the licence holder‘s family physician or even the
DME/SME, if they are providing medical care. Hence, all airlines are expected to have a
Medical Unit or at least a Medical Officer, in their organisation who will be responsible to
look after the health and follow up of such flight crew and other personnel of the airline.
The following descriptions include common conditions in the general population, so also in
the aviation personnel. These guidelines, though meant for all applicants and holders of all
classes of medical assessments, are more directed to the flight crew.
These guidelines are given in order to help the SMEs, DME and CAMA to deal with such
medical conditions and to have a scientific, sound and uniform process for assessing the
applicant for or holder of a licence. Using these guidelines and appropriate actions and
decisions, CAMA will attempt to grant or renew licences whenever it is possible to do so without
compromising flight safety. However, these guidelines are not necessarily final and may be
modified from time to time on the basis of further knowledge and experience.

5th Edition
3.2. NEURO-PSYCHIATRIC CONDITIONS

Neuro-psychiatric symptoms vary from mild anxiety symptoms due to day-to-day events and
stresses, to severe and incapacitating disorders. If there is doubt or suspicion during the
medical examination or on verifiable information from an identifiable source, psychiatric
evaluation will be required detailing an expert opinion and recommendation.
3.2.1 Anxiety based disorders (Neurosis): An applicant with a history of anxiety-based
disorders of significant severity requiring psychotropic medication, or admission in hospital,
or prolonged treatment or recurrence, are normally rejected for all classes of licence.
A licence is suspended or is not issued during a psychiatric illness and while the applicant is
undergoing treatment. But if the illness was not of a long duration and the psychotropic drugs
were stopped for 6 months or more, the applicant may be considered for issue or
recertification on the psychiatrist's accredited medical opinion with restrictions such as 'to fly
as or with suitably qualified co-pilot in the multi-pilot aircraft' or 'to fly with safety pilot with
dual control in single pilot aircraft' for 6 months after which they shall be re-evaluated.
3.2.2 Sociopathic Personality Disorders: All such cases, if proved, are assessed as unfit for
all classes of licence.
3.2.3 Psychotropic Substance or Alcohol Abuse: These reduce performance, slow reactions
and impair judgment. The detrimental effects persist even after these substances have been
eliminated from blood. There exists every chance of a recurrence of symptoms, even after
ceasing use.
A history of abuse, or current effects of abuse of these substances may be incompatible with
flying. After successful treatment and complete abstinence for six months or more, the
applicant may be considered for issue or recertification upon the psychiatrist's accredited
medical opinion and provided abstinence is secure and three-monthly follow-up is
maintained. The issue or recertification will be endorsed with restrictions, such as 'to fly as, or
with, a suitably qualified co-pilot in multi-pilot aircraft', or 'to fly with a safety pilot with dual
control in single pilot aircraft‘. Failure to comply, or evidence of a relapse will make the applicant
permanently unfit.
3.3 NEUROLOGICAL CONDITIONS

3.3.1 Seizure: Disturbance of consciousness in flight personnel is usually due to transient
cerebral hypoxia following syncope, or more rarely due to a cardiac disorder or an epileptic
seizure. An epileptic seizure occurring during flight is an unacceptable safety hazard, even in
multi-pilot aircraft. It may be a partial seizure and not immediately apparent to the other pilot
or a generalized tonic-clonic seizure, the consequence of which may disrupt the equipment or
cause loss of control. This may be especially hazardous if it occurs during take-off or landing.
Hence it is important to be sure whether it is due to 'faint,' or 'fit i.e. seizure'.
Epilepsy is a recurrent seizure and causes sudden incapacitation. Hence, the diagnosis of
epilepsy leads to permanent failure in all classes of medical assessment.

5th Edition
Single seizure, if afebrile and unprecipitated, may be assessed as fit for certification after 10
years, provided there is no recurrence, and the applicant is off drugs for five years or more.
The applicant will also require a normal EEG and MRI of brain and a neurologist's opinion
that there is no likelihood of having another seizure. The licence will be endorsed with
restrictions such as 'to fly as or with suitably qualified co-pilot' in multi-pilot aircraft or 'with
safety pilot with dual control in single pilot aircraft' for one year, after which the restriction
may be lifted.
An applicant with a history of childhood febrile seizure, occurring before the age of 5 and
not associated with neurological deficit, may be considered as fit for certification.
Post-traumatic epilepsy is disqualifying.
Abnormal EEG or MRI or recurrence of epilepsy, following a previous history of epilepsy
will be permanently disqualifying.
3.3.2 Head Injury: Accidents associated with head injuries are common in the modern
world.
Head injury with loss of consciousness and focal neurological deficit, depressed skull
fracture, cerebral injury or post-traumatic headache will be disqualifying.
There are two major concerns following head injury with loss of consciousness. One is the
neuro-psychological consequences of the head injury in the individual, though without focal
neurological deficits, could be in the form of dysfunction in number of functional executive
activities of brain. This is the effect of acceleration or deceleration forces on the skull and the
brain causing damage to cortical and diffuse white matter. The other concern is the possibility
of seizures. Both are incompatible with flight. The duration of loss of consciousness and
length of post-traumatic amnesia both show a good correlation of severity of brain damage
and occurrence of epilepsy.
Probability of epilepsy is greater in those with penetrating skull injuries. Even with full
physical and neuro-psychological recovery there is an increased probability of seizures for
over 10 years. In general, those who develop post-traumatic seizures, 50 % will occur within
one year and 70 – 80% within two years. Thereafter the incidence is 3 – 5 % per year,upto ten
years.
Risk Factors for Late Post-Traumatic Epilepsy

Incidence of late seizures (%)
Penetrating injury caused by missiles 53
Intracerebralhaematoma – laceration 39
Focal brain damage on early CT scan 32
Early seizure 25
Depressed fracture – torn dura 25
Extradural or subdural haemorrhage 20
Focal signs (hemiplegia, aphasia.) 15
Depressed skull fracture 15
Loss of consciousness > 24 hours 5
Linear fracture 5
Mild concussion 1
Pagni C.A. ActaNeurochirurgica, Suppl. (1990)

5th Edition
Recommendation minimum period of grounding on duration of

period of post-traumatic amnesia (PTA)
Duration of PTA Minimum recommended period
Momentary Two – six weeks
More than one hour Two months
More than 12 hours Four months
More than 24 hours Six months
More than one week 12 months
Depending upon the initial level of risk, if the epilepsy has not occurred two years after a
head injury the reduction of risk may allow a pilot to return to flying without restriction or as
or with, a co-pilot. After five years this restriction may be removed.
Head injury with loss of consciousness and after complete recovery of mental and
neurological function may be assessed as 'fit', with or without restriction, after a complete
neurological examination and appropriate laboratory and imaging studies. However, a period
of stabilization and an Accredited Medical Opinion is required before the applicant is
recommended.
3.3.3 Headache: A headache is a common symptom and mostly mild and short lived. But
some may be severe and incapacitating, and chronic or recurring and so hazardous to flight
safety.
Migraine: Some migraines present as frequent attacks of severe headache associated with
aura, particularly the disturbance of sight, and neurological disturbance, prostration from
vomiting, photophobia and occasional loss of consciousness. A chronic sufferer may be
assessed as unfit for certification. Some sufferers may be considered for recertification and
assessed as ‗fit to fly as, or with a suitably qualified co-pilot in multi-pilot aircraft' or 'with a
safety pilot with dual control in single pilot aircraft' for one year. If the attacks of headache
are of lesser severity and infrequent, and if the applicant is receiving treatment and is free of
headaches for more than 6 months, the restriction may be lifted after one year.
Cluster Headache: Chronic cluster headache without remission is assessed as permanently
unfit. But if it occurs for a limited period followed by long period of remission, the applicant
may be certified fit with restriction 'to fly as or with suitably qualified co-pilot in multi-pilot
aircraft' or 'with a safety pilot with dual control in single pilot aircraft' with a suspension of
licence required during any relapse.
3.3.4 Neuralgic Pain: Neuralgic attacks of sudden severe pain, as in trigeminal neuralgia
and other neuralgias, are distracting and incapacitating and applicants with such a history
are assessed as unfit. If the applicant becomes free of pain spontaneously or after operation or
with treatment and remains so for more than six months without treatment, they may be
considered for recertification, with or without restriction. A neurologist opinion may be
required.
3.3.5 Infection: Infection of the nervous system can occur sometimes in aviation personnel.
Viral Encephalitis: Generally, an applicant who has suffered from viral encephalitis would
be assessed as permanently unfit, as they often have a residual neuropsychological deficit.
Viral Meningitis: A applicant who is neurologically normal two months after viral
meningitis, will be assessed as fit in all classes.
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Bacterial Meningitis: An applicant who has completely recovered from bacterial meningitis
may be assessed as medically fit after one year, provided he is found to be normal on
neurological examination, electroencephalogram, and CT scanning and if there is no focal
neurological deficit.
Bain Abscess: An applicant who has suffered from a brain abscess is assessed as
permanently unfit due to increased risk for epilepsy from the scarring that forms round the
abscess.
GuillainBarre Syndrome: Applicant who has made a full recovery from GuillainBarre
Syndrome may be assessed as fit. If they have mild residual weakness, they may also require
a flight test.
3.4 CARDIO-VASCULAR CONDITIONS
3.4.1 Hypertension: Hypertension is a common condition in the adult population and can
cause long term changes, if not controlled, e.g. damage to major organs including heart, brain,
kidneys and eyes. Hence, it can be the cause of incapacitation jeopardizing the safety of
flight. Hypertension is a common cause of premature loss of licence.
Blood pressure measurement: Blood pressure measurement will be done both in seated and
recumbent positions. The systolic blood pressure shall be recorded at the appearance of the
Korotkoff sounds (phase I) and the diastolic blood pressure at their disappearance (phase V).
If the blood pressure is raised and the resting heart rate is rapid, further observation should be
made during the medical examination after some rest.
Hypertension will be suspected if blood pressure is recorded at 140/90 mm of Hg or more in a

sitting position after adequate rest. It will be confirmed if it is consistently so on weekly
blood pressure examinations for 4 weeks. Hypertension is classified as per new National
Heart and Lung and Blood Vessels Institute (NHLBI) Standards (May 2003), as given below:
Condition Systolic (mm of Hg) Diastolic (mm of Hg)

Normal <120 <80
Prehypertension 120 – 139 80–89
Stage I Hypertension 140 – 159 90–99
Stage II Hypertension >160 >100
If the readings are above 140/90 mm Hg but below 160/100 mm of Hg i.e. Stage I
Hypertension, an ambulatory blood pressure measurement (ABPM) for 24 hours will be done
to eliminate the white coat and anxiety induced hypertension.
If 2 blood pressure measurements done at weekly intervals are more than 160/100 mm of Hg
i.e. Stage II Hypertension, no ABPM will be required.
24 hours ambulatory blood pressure measurement: It is programmed to record the blood

pressure every 30 minutes during the day time and every 60 minutes during night time. The
applicant is instructed to keep the arms still during measurements and continue his daily
activities other times. He is also to record the activities as well as time of going to bed and
time of rising. For analysis more than 14 systolic and diastolic blood pressure records during
the day time and at least 7 records at night are mandatory.
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Definition of normal blood pressure and hypertension using ABPM is given below:
Normotension Hypertension
(Upper limits by rounding (Upper limits by rounding
downwards 0-5 mmHg) upwards 0-5 mmHg)
For 24 hours average 130/80 mmHg >135/85 mmHg
For day time average 135/85 mmHg >140/90 mmHg
For night time average 120/70 mmHg >125/75 mmHg
The applicant with hypertension diagnosed for the first time, will require cardiovascular
evaluation for medical assessment including risk factors and target organs, and consist of:
 Detailed history including family, personal & social,

 Blood tests – Hb, ESR, urea, creatinine, electrolytes, fasting lipid profile, uric acid and
fasting blood sugar

 Urine analysis

 Chest X-Ray

 Electrocardiogram

 Echocardiogram

 Exercise Electrocardiogram Test
The applicant who is diagnosed with 'Stage I Hypertension' will be treated initially with non-
pharmacological means and monthly blood pressure recording for three to six months,
maintaining their flight status, and then with approved anti-hypertensive drugs, if necessary.
The applicant diagnosed with 'Stage II Hypertension' will be certified 'unfit temporarily' for
flight duty. Meanwhile an attempt will be made to control the blood pressure by non-
pharmacological means and any antihypertensive drug dosage will be adjusted if the
applicant is already in treatment. A minimum period of 2 weeks classed as unfit should be
imposed from the application of, or dosage change of, approved drug or drugs, to watch for
any adverse effects of these drugs in that dosage. During this period blood pressure will be
recorded weekly. After the control of blood pressure, the applicant will be followed up
monthly for three months and then every 3 months, provided blood pressure control is
satisfactory.
This follow-up care should be the responsibility of the Airline doctor or the applicant‘s family
physician, or even the medical examiner, if they are providing medical care. Before
certification of medical fitness all the medical reports from the treating physician should be
provided to the medical examiner and then to the Member Coordinator.
Non-pharmacological means or modification of life style (weight reduction, minimizing
alcohol consumption and salt intake, regular exercise,) is the first approach. Cessation of
smoking and reduction of saturated fat intake are to be strongly recommended as it reduces
the associated cardiovascular risk.
The following classes of drugs have been identified as acceptable in the management of
hypertension in aviation personnel. viz. Non-loop Diuretics (Hydrochlorthiazide 25 mg/day,

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Chlorthalidone, Amiloride, Triamterin, Aldosterone) , Hydrophilic Beta-blockers (Atenolol

and Metoprolol), long acting Angiotensin Converting Enzyme (ACE) Inhibitors (Enalapril,
Lisinopril), Angiotensin II receptor blockers and Slow Calcium channel blockers (long acting
dihydroppyridines viz. Amlodipine).
During periodic examination of those controlled with acceptable drugs for renewal of licence,
the treating physician will provide a medical report and records of at least 3-monthly blood
pressure, and the applicant will undergo tests as listed above once every two years for future
aviation medical examinations.
Stage I Hypertension is certified 'fit' without restriction, except during the initial few weeks
of initiation of treatment with anti-hypertensive drugs and observation for any side effects.
Stage II hypertension is certified 'temporarily unfit' until the applicant‘s blood pressure is
controlled and the anti-hypertensive drugs cause no adverse effects. Then they will be
assessed fit without restriction.
The presence of complications of hypertension will render an applicant 'unfit'.
3.4.2 Coronary Artery Disease: Coronary artery disease is common especially in affluent
society. The incidence is on the increase in this part of the world. Sudden incapacitation is a
dangerous situation during flight and hence it is the commonest cause of the loss of licence.
Local lesions of the coronary arteries are important, but risk factors and life style are also
equally important and need to be addressed.
An applicant with a proven history or clinical diagnosis of Myocardial Infarction, with or

without symptom and with or without treatment, shall be assessed as 'unfit' in both initial and
renewal, for all classes of licence. They may be considered for recertification after one year,
if there is no significant residual damage of myocardium and no significant stenosis of
coronary artery or its branches and according to accredited medical opinion the cardiac
condition is unlikely to interfere with the safe exercise of the privilege of the licence. It will
be endorsed with a restriction for one year to fly as or with a co-pilot and this restriction may
be lifted after one year. Follow-up of annual cardiological review shall be required by a
cardiologist, including Exercise ECG and/or Myocardial perfusion scintigraphy. After 5 years
a repeat coronary arteriogram may be required.
All applicants with atypical chest pain or suspected or asymptomatic or symptomatic

coronary artery disease will be assessed as 'unfit' and shall undergo detailed cardiovascular
evaluation and investigations and require an 'accredited medical opinion'. A applicant with
angina and/or Exercise ECG positive for reversible myocardial ischaemia will be assessed
as unfit for any class of licence. If the applicant was treated with coronary angioplasty or
with coronary artery by-pass graft, they may be assessed as fit after one year from the
procedure and after cardiac evaluation and accredited medical opinion that there is no
likelihood of becoming suddenly incapacitated or interfering with the safe operation of
aircraft and the safe performance of their duties. The licence will be restricted to multi-crew
operation for one year, after which the restriction may be lifted. Follow-up with an annual
cardiological review shall be required by a cardiologist, including Exercise ECG and/or
Radioisotope Myocardial Perfusion Scan. After 5 years a full cardiological evaluation and
repeat coronary arteriogram may be required.

5th Edition
Exercise Electrocardiography: A standardized protocol such as Bruce treadmill protocol or

equivalent should be employed. The subject should be exercised to symptom limitation and be
expected to complete at least three stages – nine minutes or 11 METs. The reason for
discontinuing the test should be recorded together with the presence or absence of any
symptoms.
More than 1 mm ST depressionin Exercise ECG will be considered as positive for
reversible myocardial ischaemia. The depression should be horizontal or down
sloping and lasts more than 0.08 second duration. There may be disturbance in
conduction or/and ventricular or supraventricular extrasystoles.
Failure to achieve increase in blood pressure or occurrence of fall in blood pressure is
indicative of extensive ischaemia.
Inability to achieve predicted heart rare target renders the test inconclusive rather than
negative.
a. Absence of reversible ischaemia will rule out coronary artery disease.
b. Presence of reversible ischaemia shall have coronary angiogram, and further action
will be taken on the findings.
Coronary Angiogram: Significant stenosis is defined as a coronary artery or its main
branches being obstructed more than 30 % and minor branches more than 50 %.
(a) Absence of significant stenosis in any coronary artery or its branches shall be defined
as a false positive exercise ECG.
(b) Presence of significant stenosis of one or more coronary artery or branches will be
disqualifying.
Applicants with ischaemic damage to the ventricle such as dyskinesia, hypokinesia or
akinesia, ejection fraction <50 and significant abnormality of wall motion shall be assessed as
'unfit'.
3.4.3 Epicardial, myocardial or valvularheart disease: Applicants withepicardial,
myocardial or valvular heart disease, with or without symptoms, treatment or surgery, shall
be assessed as unfit. Applicants without symptoms may be assessed as fit for class II Medical
Assessment after a full cardiological evaluation and accredited medical opinion, if they are
not carrying revenue passengers.
3.4.4 Vascular conditions: Applicants with the following vascular conditions shall be
assessed as unfit, viz.
Significant peripheral arterial disease, before or after surgery, and
Aneurysm of thoracic or abdominal aorta, before or after surgery.
3.4.5 Vaso-vagal syncope: Recurrent vaso-vagal syncope sufferers will be assessed as unfit.
3.4.6 Rhythm or Conduction Disturbances: An applicant with a rhythm or conduction
disturbance must be evaluated to determine what extent of disability it can produce and
whether there is underlying heart disease. This may require detailed cardiological evaluation
with echocardiography, exercise electrocardiogram, Holter monitoring, etc.
3.4.7 Coronary Calcium Score: This test uses CT (Computerised tomography) to detect
calcium deposits in coronary arteries. A higher calcium score denotes a higher chance of
significant narrowing of coronary vessels with subsequent higher heart attack risk.
In view of high cardiovascular events including myocardial infraction, this test would aid to
further elucidate coronary events especially in borderline or mildly positive (TMT) Tread Mill
Test cases.

5th Edition
Commonly occurring conditions like respiratory arrhythmia, occasional uniform atrial or

ventricular ectopic complexes which disappear on exercise, rapid heart rate from
excitement or exertion, slow heart rate not associated with auriculo-ventricular dissociation,
may be regarded as being within normal limits.
Supra-ventricular premature beats or ectopicsare usually of less importance, but some of

them may predispose to supraventricular tachycardia, atrial flutter or atrial fibrillation.
Supraventricular tachycardia may accompany illnesses like Pneumonia or Thyrotoxicosis,

in which case the disease itself will disqualify the applicant until successfully cured or
controlled.
Paroxysmal supraventricular tachycardia can cause distraction and in some cases is

incapacitating. Applicants with successful therapy with anti-arrhythmic drugs need not be
disqualified. Ablation therapy should be confirmed to be successful by repeat
electrophysiological studies after 3 months. A licence restriction is applied as to fly in multi-
crew aircraft or to fly with a safety pilot for three months, after which the restriction may be
lifted.
Ventricular premature beats in the presence of cardiac disease is a disqualifying condition.
It is also more likely to be associated with serious ventricular tachycardia and hence
disqualifying if the applicant presents with one or more of the following characteristics:
(a) Prolonged Q-T interval,
(b) Occurrence in close proximity to the vulnerable period i.e. R on T phenomenon,
(c) Occurrence in pairs or regularly coupled to the normal QRS complex in bigeminy,
(d) Multifocal origin,
(e) Post-extrasystolic T inversion or post-extrasystolic ST depression, and
(f) Increase in frequency with stress.
The applicant may be assessed as fit with a density of < 200/hour if non-invasive
investigations are satisfactory, but a multi-crew endorsement is usually applied.
Applicants with broad and/or narrow complex tachycardia shall be assessed as 'unfit'.
Isolated sinus node dysfunction including sinus Bradycardia, may occur in healthy young
people, particularly those engaged in vigorous exercise. Such finding need not disqualify the
applicant.
Sinoatrial disease may remain relatively free of symptoms for years. An applicant who is
asymptomatic may be assessed as fit, but with a restriction to multi-crew operation. A regular
review with exercise electrocardiogram for chronotropic incompetence and Holter monitoring
are required. Once symptomatic, the applicant shall be assessed as permanently unfit.
Atrial fibrillation may be encountered during a medical examination. Leaving aside the
possibility of other disqualifying conditions which may coexist, the importance of atrial
fibrillation is its possibility to cause distraction, subtle incapacitation and the risk of thrombo-
embolism. An applicant with asingle episode with a defined cause e.g. vomiting, which is
self-limiting with spontaneous reversion to sinus rhythm, should eventually get unrestricted
flying status, though in the beginning are endorsed with multi-crew status. The need for DC
conversion does not necessarily imply a bad prognosis. Other types of atrial fibrillation are
paroxysmal or persistent or permanent atrial fibrillation.The presence of structural or
5th Edition
metabolic abnormality, or of ischaemic, hypertensive or valvular heart disease, or

thyrotoxicosis or possibility of alcohol abuse will disqualify the applicant from flying. Lone
atrial fibrillation, without any obvious pathology may be assessed as fit with restriction to
multi-crew operation, if asymptomatic. Permissible medications to reduce the ventricular rate
are Digoxin, Beta blockers and Verpamil.
Fist degree or second degree (Type I) should be investigated to rule out heart disease and to
determine the risk of complete heart block. This can be seen during rest, particularly sleep, in
young adults who engage in vigorous exercise, and so they are assessed as fit without
restriction.
Bundle branch block: Isolated bundle branch block and left hemiblocks, which are long
standing, are generally benign. Applicants with complete right or left bundle branch block
require cardiological evaluation on first presentation.
3.4.7 Congenital heart diseases: Sometimes an applicant with congenital heart disease may
apply for initial or renewal of the licence. The condition may be known earlier or maybe
detected for the first time.
Small or early (<24 years) corrected secundum atrial septal defect is compatible with
unrestricted flying subject to regular review, but departure from this requirement implies
restricted flying or denial of licence.
Small ventricular defect may be assessed as fit as it tends close spontaneously or remain
stable. Closure in childhood likewise carries a good outcome.
Coarctation of aorta: An applicant who has undergone surgical correction after the age of
12 is assessed as unfit due to increased risk of sudden death and incapacitation due to
cerebrovascular accident. An applicant who had undergone successful correction before the
age of 12 may be certified as fit.
3.4.8 Innocent murmurs: Murmurs do not necessarily mean a valvular heart disease. If it is
diagnosed to be innocent murmurs, the applicant may be given unrestricted flying status.
They may, however, need cardiologist confirmation with non-invasive tests.
3.4.9 ECG Findings: They are listed below in different categories
ECG Findings
• Normal Tracing - Fit
• Normal Variant - Fit
• Borderline – Requires evaluation
• Abnormal Tracing – - Unfitimmediately, or after evaluation
Normal Variants
Require no further evaluation
 Isolated Sinus Tachycardia
 Sinus Bradycardia
 Sinus Arrest – less than 2 seconds in duration

5th Edition
 Sinus Arrhythmia
 Wandering Supraventricular Pacemaker
 Nodal Rhythm
  Sinus Rhythm (Atrial Rhythm)
 Atrial Premature Extrasystole(s)
 Nodal Premature Extrasystole(s)
 Nodal Escape Beat
 Atrial Escape Beat
 Premature Ventricular Contraction, Unifocal, less than 30
  Ventricular Escape Beat
 Interpolated Extrasystoles
 Ventricular Bigeminy, Trigeminy, less than 30
 Ventricular Parasystole, less than 30
 Terminal Intraventricular Conduction Defect
 Unclassified Intraventricular Conduction Defect
  Nonspecific ST elevation (Early Repolarization)
 Post-extrasystolic T Wave Changes
 PVC‘s (Unifocal) after Exercise
 PVC‘s (Unifocal) during Exercise
  S1, S2 or S1, S2, S3 Pattern
 Right Bundle Branch Block (RBBB) – in absence of organic disease
Borderline i.e. Possibly Significant Abnormal Tracing, requires further evaluation

• Sinus Tachycardia – if persistent and present during basal resting state
– Med Eval, Cardiac enzymes, T3, T4 & TSH, Echocardiogram, TMT &Holter
• Paroxysmal Atrial or Nodal Tachycardia, Atrial Flutter or Atrial Fibrillation precipitated
by well–documented unusual circumstances
– Med Eval, Cardiac enzymes, T3, T4 & TSH, Echocardiogram, TMT &Holter
• First Degree A-V Block (>0.20 sec)
– Med Eval, Echocardiogram, MT &Holter
• Wenckeback (Type I A-V Block)
– Med Eval, Echocardiogram, TMT &Holter
• A-V Dissociation
• Low Amplitude T Wave or Non-specific T wave Changes (in fasting condition)
• Non-specific ST Depression (in fasting condition)
• Abnormal TMT (1.0 mm or greater ST depression, horizontal or down sloping, of more
than .08 sec duration
– Med Eval, Echocardiogram, Holter, Thallium Scan, Coronary Angiogram may be
required
• Poor R wave Progression
• PVC‘s (for the first time, over 30 years old) including Bigeminy, Trigeminy&Parasystole
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• Right Bundle Branch Block (RBBB) (new appearance)

• Left Bundle Branch Block (LBBB) –
• Wolff-Parkinson-White Syndrome (WPW)
• Lown-Genang-Levine Syndrome (LGL)
• Left Axis Deviation (LAD) (> -300)
• Right Axis Deviation (RAD) (>1200)
• Pericarditis – repeat after 6 months
Significant Abnormal Variants
 Disqualifying for all classes.
 Usually do not require further evaluation
  Serious enough to warrant complete medical evaluation

 If found in personnel already on flying duty, usually a basis for suspension of flight

privileges.
• Sinus arrest – occurring spontaneously for a period of 2 seconds or more or when
associated with symptom
• Paroxysmal atrial or nodal tachycardia, atrial flutter, or atrial fibrillation, unless it is an
isolated occurrence precipitated by well- documented unusual circumstances, e.g.
excessive fatigue, infection, ingestion of medicine, alcohol or toxic agent, not associated
with WPW
• Idioventricular rhythm
• Ventricular tachycardia – 3 or more successive ventricular contractions
• Paired PVC‘s
• Ventricular fibrillations
• Multifocal PVC‘s
• Second Degree A-V Block (Mobitz type II)
• Complete (third degree) A-V block
• Evidence of Myocardial ischaemia or damage, especially as a serial change
• Evidence of Myocarditis, Endocarditis
• WPW when associated with an episode of a tachyarrhythmia or suggestive of history of
same
• LGL
• LBBB, in Class I Flying personnel
• Any other ECG abnormality, indicative or significantly altered cardiac function, not
mentioned above.

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Medical Evaluation:
• History & evaluation preferably by a Cardiologist
• Laboratory investigations (CBC, ESR, urine R & M, Renal profile, Bl sugar F & PP,
BUA, Lipid profile, Thyroid function tests, PSA, LFT)
• X rays – Chest PA & Lateral views
• USG
• Other tests may be required depending upon the case
Cardiac Investigations:
• ECG - ECG at resting and fasting state
• Echocardiogram
• Exercise ECG
• Ambulatory ECG
• Radioisotope Myocardial Perfusion Scan
• Stress Echocardiogram
• Coronary Angiogram
• Coronary Calcium Test
• Any other investigations deemed necessary
3.5 RESPIRATORY CONDITIONS
Respiratory diseases are the commonest cause of morbidity and loss of time at work in the
general population. The disease, not so symptomatic on the ground, may cause problems and
incapacitation in the aviation environment.
3.5.1 Bronchial Asthma: An applicant with a recent attack of bronchial asthma shall be
assessed as 'unfit for initial issue of licence. Recurrent attacks shall be assessed as 'unfit for
renewal of licence. The applicant may be considered for certification only after being free
from attacks for 5 continuous years. A history of childhood asthma alone is not
disqualifying.
3.5.2 Chronic obstructive airway disease requiring continuous medications shall

be
assessed as unfit. The individual assessment is made on the basis of severity of disease, type
and amount of medication required, full history, pulmonary function test. The
treating
physician or chest physician's report is usually required.
3.5.3 Pneumonia: Unfit until fully recovered.
3.5.4 Pulmonary Tuberculosis: An applicant or holder will be assessed as unfit during

active tuberculosis and in the initial phase of treatment for at least two months. Once the
patient becomes asymptomatic and there is marked clearing in the chest X ray, they may be
assessed as 'fit' with a restriction to multi-pilot aircraft while undergoing treatment.
3.5.5 Tubercular Pleural effusion, as in Pulmonary tuberculosis.

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3.5.6 Spontaneous Pneumothorax: It happens suddenly and can cause severe pain or
breathlessness. Open pleurectomy is recommended following a single event and flying duties
can be resumed 3 months after pleurectomy. If not carried out, the applicant may be
considered for recertification only after 18 months.
Recurrent spontaneous pneumothorax Flight privileges shall be removed permanently if

pleurectomy is not done. An investigation to exclude lung disease is required.
3.5.7 Pyothorax: If completely healed after medical and/or surgical treatment, the applicant
may be considered for certification after 6 months. If pulmonary functions are satisfactory,
the applicant may be assessed as fit with a multi-crew restriction. After one year the
restriction may be lifted.
3.6 GASTRO-INTESTINAL CONDITIONS
Digestive complaints or conditions are common in the general population. These can distract
or even incapacitate though most of them are just a nuisance during the flight.
3.6.1 Gastro-oesophageal reflux disease: If troublesome and symptomatic, the applicant

will be assessed as unfit. They will be reassessed as fit after symptoms are abated, with or
without acid suppressing treatment, with or without restrictions as indicated.
3.6.2 Gastric or Duodenal Ulcer: An applicant with an active ulcer confirmed on endoscopy
are assessed as unfit Before being assessed as 'fit', the ulcer must be proven healed
completely endoscopically. Continued treatment with acid suppressing agents are allowed, if
no side effects are produced.
3.6.3 Complications of ulcer e.g. haemorrhage or perforation: An applicant is assessed as
unfit for six months. After treatment and if asymptomatic, they may be assessed as fit after
re-endoscopic confirmation. Continued treatment with acid suppressing agents are not
disqualifying. The licence may be endorsed as restricted to flying in multi-crew operations
for six months.
3.6.4. Chronic Inflammatory Bowel Disease: An applicant with chronic inflammatory
bowel disease shall be assessed as unfit.
3.6.5 Cholelithiasis / Cholecystitis: Applicants with symptomatic cholelithias is will be
assessed as unfit and will be assessed as fit only after cholecystectomy and full recovery.
Asymptomatic incidental finding of a large solitary gall stone may not restrict an applicant
from being assessed as fit. Applicants with acute Cholecystitis are certified unfit and will be
certified fit only after symptoms are controlled after treatment.
3.6.6 Hernia: Significant hernias are disqualifying until they are repaired.
3.6.7 USG: Ultrasonography gives a graphic information of different abdominal organs
.
especially the liver, gall bladder, kidneys, adrenals and of female reproductive organs. Both
renal and GB calculi along with alcohol abusive liver being prevalent in our society, it's an
importance investigation tool

5th Edition
3.7 GENITO-URINARY CONDITIONS
3.7.1 Haematuria: An initial applicant with haematuria should be investigated before final
assessment is given. Others who are found to have isolated microscopic haematuria during
routine medical examination, may be assessed fit while further investigations are carried out.
In case of frank haematuria, their licence should be suspended, or medical assessment result
is withheld until the investigations are completed.
3.7.2 Proteinuria: Trace protein result can occur in as little as 50 mg of protein in a litre of
urine and 1+ at about 300 mg in a litre of urine. On finding 1+ proteinuria, one should get 24
hours excretion of protein in urine. An applicant for initial licence with proteinuria should be
investigated before final assessment is given. Applicants for renewal and licence holders with
isolated mild proteinuria (<1 gm in 24 hours) may continue to fly whilst awaiting
investigations and may be allowed full flying duties without restrictions. If Significant
proteinuria (>1 gm in 24 hours) is found, the medical licence result is withheld or the licence
suspended pending the results of investigations. If associated with haematuria, hypertension,
renal impairment or signs of systemic disease, the applicant should be assessed as unfit. If
proteinuria is an isolated finding, they may be assessed as fit with restricted multi-crew
operations, provided that there is careful follow-up at a minimum of six-monthly intervals.
3.7.3 Urolithiasis: Urolithiasis or stone in the urinary tract is a common condition in the
general population. The concern is the sudden incapacitation due to colic that it can produce.
Once the applicant or holder is suspected of or diagnosed with urolithiasis, further urological
evaluation is mandatory. The stone may pass per urethra or be removed by extracorporeal
shockwave lithotripsy (ESWL) or operation, but it can recur in course of time. Hence follow
up is important.
Urological evaluation includes, as follows:

Full history including family history
Urine examination - routine and microscopic examination
Blood examination – urea, creatinine, electrolytes, calcium, uric acid
Intravenous urogram (IVU)
Ultrasound of abdomen and pelvis
Biochemical tests
Other tests as deemed necessary
Asymptomatic stone: Any stone in the urinary tract, even without symptoms, will require
further evaluation.
 If it is lying in the parenchyma and causes no obstruction, the applicant may be
 certified fit without restriction.
 If it is lying in collecting system with or without obstruction, their licence is
suspended until the stone is cleared. Ultrasound of abdomen and pelvis will be
required in every medical assessment.
Symptomatic Stone: If the stone is causing colic pain, their licence is suspended until the
stone is cleared.

5th Edition
Recurrent Stone: It is important to follow up closely for a recurrence of stones by means of

ultrasound in each medical examination.
3.8 METABOLIC, NUTRITIONAL AND ENDOCRINAL CONDITIONS
3.8.1 Obesity: Gross obesity, Applicants with a BMI of more than 40, will be assessed as
unfit for all classes of medical assessments. Obesity, BMI more than 30, in an applicant will
require further evaluation, especially for risk factors of cardiovascular diseases and obesity-
associated health problems, before the applicant is assessed as fit. They may also be required
to be tested in the aircraft and cockpit to ensure unrestricted movement and ability to operate
the aircraft.
3.8.2 Serum lipids abnormality: Serum lipids estimation (serum cholesterol, triglyceride,
HDL & LDL): The concern with disturbance of lipid metabolism is accelerated atherogenesis
and so potential increase in the risk of sudden cardio-vascular incapacitation in the aviation
personnel.
The serum lipids estimation is to be done in the fasting stage. All the lipid components are to
be maintained within normal limits. It is even more important in the presence of hypertension
and /or coronary artery disease and family history. In such cases and in the presence of other
risk factors, it is to be maintained at further lower levels, which are to be controlled by life-
style modification e.g. reduction in alcohol, cessation of smoking, and increased exercise. If
lipids do not come down to a satisfactory level in two periods of 3 months on non-
pharmacological means, Statin medications are to be started.
At the start of medication, the licence holder shall not be allowed to exercise the privilege of
their licence to ensure that it has not caused significant side effects. During licence renewal,
lipid profiles will be required. Lipid profile abnormality alone will not downgrade their
medical fitness.
3.8.3 Diabetes: Diabetes mellitus is a common condition in the population and half of the
sufferers remain undiagnosed. The incidence is on the rise in this part of the world and it is
also found in aviation personnel. The problems in the aviation environment could be from
diabetes as well as from its associated complications e.g. marked increase in coronary artery
disease, visual problems and nephropathy. The other problem is from the treatment causing
hypoglycaemia which can be severe and sudden or mild and subtle. Both are serious hazards
to flight safety.
Glycosuria found at 'Medical Examination' or at any other time requires that the licence be
suspended until full investigation has been undertaken.
Should a diagnosis of Impaired glucose tolerance (IGT) or Diabetes be made, the licence
must remain suspended until stable control is achieved from diet and/or approved oral anti-
diabetic agents and maintained for three consecutive months.
Typical symptoms of diabetes mellitus are weight loss, polyuria and polydipsia. A finding of
glycosuria and an elevated blood sugar are diagnostic, however, the difficulty arises when
mild glycosuria and subsequent abnormal blood glucose levels are found in a symptomless
5th Edition
applicant during routine medical examination. Abnormal blood glucose requires glucose
tolerance testing.
Diabetes may be controlled on diet alone or oral anti-diabetic agents or insulin may be
required depending on the type and severity of diabetes.
Should diabetes control be obtained satisfactorily by modification of diet alone, all

classes of licence are restored.
A Diabetic controlled on acceptable combination of anti-diabetic medications, will be

assessed as fit. The combination may include up to three drugs from the following groups.
  Biguanides
  Thiazolidinediones
  GLP-1 Mimetics
  DPP-4 Inhibitors
 Alpha-glucosidase inhibitors
An applicant, once diagnosed as impaired glucose tolerance or diabetic, should be on regular

follow-up under a diabetologist or physician and should provide a report from them during
the medical examination. All cases of impaired glucose tolerance or diabetes on controlled
with diet or approved oral anti-diabetic agents for consecutive three months will be endorsed
with restriction to multi-crew aircraft for one year, and then the restriction will be removed if
the condition is maintained in satisfactory control. Continued licence approval will
necessitate regular medical monitoring and maintenance of a satisfactory blood sugar level,
freedom from ketonuria and glycosuria and that cardiovascular, neurological, renal and
ophthalmological states remain normal. In all subsequent medical examinations for renewal
of licence, the applicant will have urine routine and microscopic examination, 2 hours blood
sugar after glucose load and Glycosylated haemoglobin, which should be in acceptable limit.
They also should provide a report from their regular doctor. Once a year they will have
Exercise ECG test and fundoscopic examination after pupil dilatation.
Failure of control of diabetes will cause suspension of the licence. Frequent failure to
maintain the control of diabetes may be cause an assessment as unfit permanently.
Should diabetes control be obtained only by the use of sulphonylureas or insulin, the
applicant will be assessed as 'unfit.'
Diabetes with overt complication, though under control, the applicant will be assessed as
permanently unfit.
Glucose Tolerance Test: 75 G of glucose loading in a minimum of 250 ml of water is given

to a fasting subject who has eaten a normal diet containing not less than 250 G of
carbohydrate for the previous few days. Normal activities during those three days and rest
for half an hour before test. No further activities until the test is completed.
No smoking in the morning and during the test. Test is to be done before 10 AM, preferably.
Fasting 2 hours post glucose load

5th Edition
Normal <120 mg/100ml <120 mg/100ml

<6.7 mmol/ 6.7 mmol/l
Impaired glucose tolerance <120 mg/100ml 120 – 180 mg/100ml
<6.7 mmol/l 6.7- 10.0 mmol/
Diabetes mellitus >120 mg/100ml >180 mg/100ml
>6.7 mmol/l > 10.0 mmol/l
3.8.4 Thyroid Disorder: Both hyper- and hypo-thyroidism are incompatible with safe
performance of duties and continued licensing.
Hyperthyroidism: Once diagnosed and confirmed by thyroid function tests, the licence will
be suspended and the applicant will be given appropriate treatment (medical or radio-active
iodine or surgical) under the care of an endocrinologist or physician. After maintenance of
euthyroid state including normal thyroid function tests for a sufficient length of time i.e. not
less than 3 months and with good range of eye movements and no diplopia, the applicant may
be assessed as medically fit with restriction to operate in multi-crew aircraft for one year and
subsequently the restriction may be lifted. The licence will, however, be dependent upon
continuing periodic review with thyroid function tests and a medical report from the treating
physician throughout the flying career.
Hypothyroidism: Similarly, on being diagnosed and confirmed by thyroid function tests, the
licence will be suspended. The applicant will be given Thyroxine under the care of an
endocrinologist or physician. After maintenance of euthyroid state including normal thyroid
function tests for a sufficient length of time i.e. not less than 3 months, they will be assessed
as medically fit with restriction to operate in multi-crew aircraft for one year and
subsequently the restriction may be lifted. The licence will, however, be dependent upon
continuing periodic review with thyroid function tests and a medical report of the treating
physician throughout the flying career,
3.8.5 Pregnancy: Though pregnancy is a normal physiological process, it causes major

anatomical and physiological disturbances and stress in the system which are associated with
increase in incapacitation.
During the first trimester the chances of spontaneous abortion are there, and till 20 weeks of
pregnancy bleeding per vagina and crampy abdominal pain can occur. Pregnancy is to be
confirmed as early as possible and thereafter the applicant should have regular anti-natal care.
After 26 weeks there can occur gastro-intestinal disturbances due to hormonal change and
anatomical displacement. Even foetal movement in the womb can be discomforting and
distracting. Hence, the applicant should be under monthly obstetrical assessment and only
after the clearance from that assessment she should be allowed to continue to exercise the
privileges of the licence.
She also should be able to consider disqualifying herself in the presence any discomfort or
symptoms. They are faintness, dizziness or vertigo, nausea or vomiting, anaemia (Hgb<10 G
%), glycosuria or proteinuria, urinary tract infection, vaginal bleeding, abdominal pain, high
blood pressure, etc.
In general, it is advisable to suspend the licence in the first trimester and after 26 weeks of
pregnancy. An obstetrician's report is necessary.

5th Edition
The flight crew should be informed of the hazards of low pressure and radiation to the foetus
during flight.
4 – 6 weeks after confinement or termination of pregnancy, the applicant should have a

medical examination and assessment to confirm involution has taken place before she
resumes flight duties.
3.9 MUSCULO-SKELETAL CONDITIONS
The musculo-skeletal system is concerned with stability, power, movement and activities.
Any significant deficiency can be a threat to flight safety. If any doubt exists, the applicant
should be tested in an actual aircraft during access and exit, in use of controls during flight,
and in emergencies and evacuation under the instructor.
3.9.1 Upper Limb: A good range of joint movement, power and dexterity of upper limbs is
required in flight crew in order that aircraft controls, which are positioned not only in front of
but also to the side of, and above the seat, can be reached and used.
Injuries of the upper limbs are common in the young due to accidents and sport activities.
Traumatic dislocation of shoulder joint or gleno-humeral joint in a crew member will
disqualify them from flying. Only after 8 - 10 weeks of reduction and rehabilitation and full
activities he may the applicant return to full flight status. In these cases, recurrent dislocation
can often follow. In that case only after surgical repair and full recovery of function may they
be assessed as fit, initially with restricted operation in multi-crew aircraft and later cleared for
solo flights. Clavicular fracture, disruption of acromio-clavicular joint, and rotator cuff
injury shall also be deemed temporarily incapacitating.
Elbow movements, functionally speaking are complimentary to those of the shoulder

complex and therefore some reduction of elbow flexion and extension in acceptable. But
restriction of forearm rotation, whether it is as a result of elbow condition, malunion of old
forearm fracture or disruption of radio-ulnar joint is unacceptable.
Ability to perform three basic types of activity of grasping, pinching and hooking are
fundamental to normal hand function. These three movements with normal coetaneous
sensibility are essential for the safe manipulation of aircraft controls. Limitation of
movement of the joints, painful conditions, weakness and lack of sensation due to nerve
lesion will require suspension of the licence. Freedom of symptoms for at least six months is
required before the applicant may be considered for reassessment regarding fitness for flight
duty
3.9.2 Lower Limb: Adequate lower limb function e.g. stability, power and adequate range of
movement, is essential for access and exit of the aircraft and safety in flight. Limitation of
flexion in hip joint to less than 90 degrees from neutral position from any cause is considered
hazardous. Similarly, a painless range of movement of the knee of at least 90 degrees of
flexion from fully extended position is required. Almost full range of painless and stable
movements of ankle and subtalar joints are required for the safe control of the aircraft.
Presence of unbalanced paralysis or weakness and foot drop as a result of the first sacral root
involvement due to disc prolapse, can result in an inability to control aircraft safely

5th Edition
3.9.3 Thoraco-lumbar Spines: Low back aches area common symptom in the younger age
group, and more so in helicopter pilots. When symptoms are present, the licence should be
suspended until they become symptom free. Lumbar disc lesions are common and can be
disabling. Those with sciatica due to disc prolapse may need to undergo surgical treatment.
Lesser degree of slip disc, grade I and those who had single level spine fusion to control the
symptoms are considered fit for unrestricted flying role. Higher grades of slip disc are usually
disqualifying as they are associated with higher incidence of neurological abnormalities.
3.10 EAR, NOSE & THROAT CONDITIONS

Drum Perforation: A single dry perforation is acceptable. An acute perforation will result in
the applicant being declared unfit until hearing and tympanic membrane recovers.
Otitis media: Unfit until fully recovered.
Sinusitis: Unfit until fully recovered
Vertigo: Vertigo or giddiness is a common experience to many and usually it is transient and
of no consequence. Persisting and recurring vertigo in incompatible to safe flying.
Recurrent vertigo due to paroxysmal vestibular disorder and benign positional vertigo
requires an assessment as permanently unfit, as it is recurring symptom. In case of an
applicant with acute vestibular disturbance where the cause is thought to be due to a
transient disorder of the peripheral labyrinth with full recovery with normal neurological
assessment, they may be certified fit without restriction. Meniere's Disease is disqualifying,
but the diagnosis must be confirmed.
Monoaural hearing or loss of hearing in one year is disqualifying in all classes of licence.
Hearing Aid is not acceptable in all classes of licence.
Post-Surgical conditions: Though chronic or sequelae of the diseases of the ear are
disqualifying, after surgical treatment the applicant may be considered if they have regained
the function and are observed for a certain length of time. An applicant with simple
myringotomy will be assessed as fit for all classes without restriction after one month of
observation, if the middle ear is dry, tympanic membrane healthy, and hearing is normal and
there is no vertigo. After simple mastoidectomy, an applicant may be assessed as fit if the
ear examination including hearing is normal and wound is healed. Tympanoplasty done for
closure perforation of ear drum also improves the hearing. If the hearing is satisfactorily
recovered and ear drum is intact and healthy, the applicant may be assessed as fit without
restriction in all class of licence after one month. Otosclerosis is a common cause of
conductive deafness in adults. But after ear surgery viz. Fenestration operation, Stapes
immobilization operation, Stapedectomy with prosthesis implantation, the applicant may
be considered for recertification if specialized ENT examination after three months of
operation finds satisfactory hearing, patent eustachian tube, no vertigo, no nystagmus and
unsteadiness on Valsalva manoeuvre or forceful nose blowing. The licence will be restricted
to fly as or with another co-pilot or safety pilot for two years observation period. After that
period the restriction may be removed.

5th Edition
3.11 EYE CONDITIONS
3.11.1 Poor vision: If an applicant having poor vision, worse than 6/60 unaided, can get
vision to 6/9 in each eye with high refractory error correction they may be considered for
recertification. They should wear either contact lens or high-index spectacle lenses.
3.11.2 Diseases of eye and adnexa cause visual or distracting ocular symptoms which in
flight crew pose flight safety issues. The presence of active disease of eyes or adnexa will
cause an assessment of temporarily unfit or suspend the licence until the condition has been
cured or stabilized and is deemed unlikely to be a safety hazard or recur. The applicant may
be assessed as fit initially in dual pilot category.
3.11.3 Cataract: A stationary cataract, or lens opacity, either congenital or acquired, if it

does not interfere with the vision, may be assessed as fit in trained flight crew and need not
impose restrictions. A cataract which interferes with the vision, orpresenile cataract,
idiopathic or acquired, requires temporary licence suspension and ophthalmic intervention.
Pseudophakia (intra-ocular lens implanted) is acceptable provided all visual requirements are
met, with or without correction, three months after surgery and refraction has remained stable
on two occasions at an interval not earlier than three months.
3.11.4 Symptomless heterophoria is considered no bar for flying status depending on the
magnitude of deviation and degree of control, but manifest squint or heterotropia are
disqualifying conditions for flying.
3.11.5 One eye or monocular vision: A flight crew with one eye or monocular vision is
assessed as unfit.
3.11.6 Corneal and refractory surgery: An applicant with corneal and refractory surgery
will be assessed as fit only if following conditions are met during each medical examination.
 All the eye drops should have been discontinued for not less than six months.
  Visual acuity shall meet the required standards.
 Refraction and visual acuity must remain stable on two consecutive measurements at
three months and six months after surgery.
There should be no ongoing treatment of the eyes.

5TH EDITION
ATTACHMENTS

5TH EDITION
ATTACHMENT: A-1/6
APPLICATION AND STATEMENT FORM

Complete this page fully using a black ballpoint pen and in block letters. See instruction page for details.
1. Full Name: 2. Date of birth:
3. Gender: 4. Address: 5. Nationality:
Male / Female/ Others Tel/Mobile: E–mail:
6. Occupation: 7. Employer/Airline name and address: 8. Family physician‘s or Airline Doctor‘s
Name:
Address:
Tel/Mobile: E–mail:
9. Aviation Licence held (type): 10. Total flight time: 11. Last Medical examination:
Licence number: Date:
Country issue: Hours Place:
Type of License applied for ATPL ( ) CPL ( ) PPL ( )
UPL( ) F/E ( ) ATC ( ) Other ( )
12. Any limitations on Licence/ Medical certificate: Yes / No 13. Have you ever had an aviation medical assessment denied, suspended or revoked
by any Licensing authority? Yes / No
If yes, details:
If yes,
Date: Place:
Details:
14. Any aircraft accident or reported incident: Yes / No 15. Aircraft currently flown (e.g. Piston engine, Turbo prop, Jet):
If yes,
Date: Place:
Details:
16. Type of application: 17. Class of medical assessment applied for: 18. Type of flying intended:
Initial / Renewal / Others I/ II / III /Others Single–crew / Multi–crew
Commercial / Instructor / Private
19. Do you smoke tobacco products? 20. Do you drink alcoholic beverages? 21. Do you currently use any medication, including non-
Yes / No prescribed medication or psychoactive substances?
Never If yes, state average weekly intake in units Yes / No
Previously: Date stopped: If yes, state name of medication,
Currently: State type: Date commenced:
Amount: Daily or weekly dose:
Number of years: Cause (Diagnosis):
Rev. 00 CIVIL AVIATION AUTHORITY OF NEPAL Page – ATTCH-A- 1

5TH EDITION
22. General and Medical history: Do you have, or have you ever had, any of the following? YES or No must be ticked after each
question. Elaborate YES answers in the REMARKS section (23) and discuss them with the medical examiner.
Yes No Yes No Yes No
101. Eye disorders/ eye surgery 117. Neurological disorders: Females Only
stroke, epilepsy, seizure, paralysis, etc. 133. Gynecological disorder
(including menstrual)
102. Spectacles and /or contact lens 118. Psychological/ psychiatric trouble of 134.Are you pregnant?
ever worn any sort
103. Spectacle/ contact lens / change 119. Alcohol/ drug/ substance abuse
since last medical exam
104. Hay fever, other allergy 120. Attempted suicide Family history of
105. Asthma, lung disease 121. Motion sickness requiring medication 135. Heart disease
106. Heart or vascular disease 122. Anemia/sickle cell trait/other blood 136. High blood pressure
Disorder
107. High or low blood pressure 123. Malaria or other tropical disease 137. Dyslipidemia
108. Kidney stone or blood in urine 124. Positive HIV test 138. Epilepsy
109. Diabetes, hormone disorder 125. Sexually transmitted disease 139. Mental illness
110. Stomach, liver or intestinal 126. Admission to hospital 140. Diabetes
Trouble
111. Deafness, ear disease 127. Any other illness or injury 141. Tuberculosis
112. Nose or throat disease or speech 128. Visit to medical practitioner since last 142. Allergy/asthma/eczema
disorder medical examination
113. Head injury or concussion 129. Refusal of life insurance 143. Inherited disorder
114. Frequent or severe headaches 130. Refusal of issue or revocation of 144. Glaucoma
aviation licence
115. Dizziness or fainting spells 131. Medical rejection from or for military
service
116. Unconsciousness for any reason 132. Award of pension or compensation
for injury or illness
23.Remarks: If previously reported and unchanged, state
24. DECLARATION: I hereby declare that I have carefully considered the statements I have made above and that to the best of my
belief, they are complete and correct. I further declare that I have not withheld any relevant information or made any misleading
statements. I understand that if I have made any false or misleading statement in connection with this application, the Authority may
refuse to grant me a Medical Assessment or may withdraw any Medical Assessment granted without prejudice to any other legal action.
CONSENT TO RELEASE OF MEDICAL INFORMATION: I hereby give my consent that all relevant medical information may be
released and submitted to the Civil Aviation Medical Assessor of the Licensing Authority and Civil Aviation Medical Assessor may
release this medical information to relevant doctor/authority if deemed necessary.
NOTE: Medical confidentiality will be respected at all times.
………………………. ……………….………………….………… ………………………………….............................

Date Signature of Applicant Signature of SME Eye/SME ENT/DME (Witness)

5TH EDITION
ATTACHMENT: A-2/6
MEDICAL EXAMINATION FORM

For use by Designated Medical Examiner
1) Name: 2) Date of Birth: 3) Sex:

Male / Female
4) Type of application: 5) Class of medical assessment applied 6) Type of flying intended:
Initial / Renewal / Others for:
Type of License applied for I / II / III / Others Single–crew / Multi–crew

ATPL ( ) CPL ( ) PPL ( ) UPL( )
F/E ( ) ATC ( ) Other ( )
7) Height (in 8) BMI: 9) Eye Color: 10) Hair Color: 11) Blood Pressure– seated 12) Pulse– resting:
cm)/Weight (in mm Hg
kg): Systolic Diastolic Rate(bpm): Rhythm:
Regular/
Irregular
CLINICAL EXAMINATION:
Normal Abnormal Normal Abnormal
22) Anus, rectum
13) Head, face, neck, scalp (examine if applicable)
23) Genito– urinary system

14) Mouth, throat, teeth (examine if applicable)
15) Nose, sinuses 24) Endocrine system

16) Ears 25) Upper and lower limbs, joints
17) Eyes 26) Spine, other musculoskeletal
18) Lungs, chest, breasts
(indicate if breasts not examined) 27) Nervous system
19) Heart 28) Psychiatric

20) Vascular system 29) Skin and lymphatic system
21) Abdomen, hernia, liver, spleen 30) General system
31) Any other relevant observation or findings:
32) Identifying marks, tattoos, scars, etc.:
33) Notes: Describe every abnormal finding. Enter applicable item number before each comment.
34) EAR, NOSE, THROAT AND HEARING (ATTACHMENT: A - 3/6)
Medical Examination Form (Ear, Nose, Throat and Hearing) filled in by Specialist Medical Examiner
Dr.……….………………………………………………………… on date …………………………… is attached.
35) EYE, VISUAL ACUITY AND COLOR PERCEPTION (ATTACHMENT: A - 4/6)
Medical Examination Form (Eye, Visual Acuity and Color Perception) filled in by Specialist Medical Examiner
Dr. ………………………………………………….…………….on date ……………………………. is attached.

5TH EDITION
Accompanying reports Normal Abnormal/comment Not performed

51) Urinalysis
52) ECG
53) Chest X-ray
54) Audiogram
55) Others
56) Mental health aspects of fitness discussed. Yes / No
57) Behavioural aspects of fitness discussed. Yes / No
58) Physical aspects of fitness discussed Yes / No
59) Preventive health advice given. Yes / No
60) Comments, restrictions, limitations:
61)Designated Medical Examiner’s Recommendation:
I hereby certify that I have examined the applicant named on this Medical Examination form. All the statements in Application and
Statement form, Medical Examination forms, along with attachments, if any, embodymy findings completely and correctly. I also
have studied specialist medical reports and have attached herewith.
I RECOMMEND / DONOT RECOMMEND for INITIAL/RENEWAL/OTHER licence as the applicant
MEETS/ DOES NOT MEET the medical standards prescribed in Medical Requirements, CAAN for CLASS I / II / III
Medical Certificate.
62) Clinic Address and Date: 63) Designated Medical Examiner‘s: 64)Designated Medical Examiner‘s
[Block Capitals and/or stamp] signature:
Name:
Telephone No:
E-mail:
Fax (if available):

5TH EDITION
ATTACHMENT: A-3/6
(Specialist - Ear, Nose, Throat and Hearing)
For use by Specialist Medical Examiner
Male / Female
4) Type of application: 5) Class of medical assessment applied 6) Type of flying intended:

Initial / Renewal / Others for:
Type of License applied for I / II / III / Others Single–crew / Multi–crew

ATPL ( ) CPL ( ) PPL ( ) UPL( )
F/E ( ) ATC ( ) Other ( ) Commercial / Instructor / Private
Normal Describe abnormality in detail, use additional

sheet if necessary & attach to this form
Yes No
14) Mouth, throat, teeth
15) Nose, sinuses
16) Ears (especially eardrum appearance and mobility)

36) Any other relevant observation or findings
37) Hearing test, back turned to examiner Whispered voice Conversational voice Rinne‘s Test Weber Test
Right ear 1m 2m
Left ear 1m 2m
38) Audiometry 500 1000 2000 3000 4000 8000
Right ear dB loss [ ] [ ] [ ] [ ][ ][ ]
Left ear dB loss [ ] [ ] [ ] [ ][ ] [ ]
39) Remarks, if any:
I certify that the applicant MEETS / DOES NOT MEET the medical standards prescribed in Medical Requirement, CAAN in
Ear, Nose, Throat and Hearing for INITIAL/RENEWAL/OTHER for CLASS I / II / III medical certificate.
If not, specify ………………………………………………………………………………………….…....... ……………………………….
Name of Specialist Medical Examiner: …………………………………………….....…… Signature: …………………………….
Place of examination: ...................................................... Date: ........................................

5TH EDITION
ATTACHMENT: A-4/6

(Specialist - Eye, Visual Acuity and Color Perception)
For use by Specialist Medical Examiner

Male / Female
4) Type of application 5) Class of medical assessment applied 6) Type of flying intended:

Initial /Renewal / Others for:
Type of License applied for I/ II / III / Others Single–crew / Multi–crew

ATPL ( ) CPL ( ) PPL ( ) UPL()
F/E ( ) ATC ( ) Other ( )
Normal Describe abnormality in detail, use additional

Yes No sheet if necessary & attach to this form
40) Eyes– orbit and adnexa; visual fields
41) Eyes –ocular motility; nystagmus, eye muscle balance
42) Eyes– pupils and optic fundi
43) Any other relevant observation or findings
44)Distant vision at 6 m
Uncorrected Glass Contact Lenses
Right eye Corrected to
Left eye Corrected to
Both eyes Corrected to
45) Intermediate vision: N14 at 100 cm
46) Near vision: N5 at 30-50 cm
47) Spectacles 48) Contact Lens

Yes No Yes No
Type: unifocal/ bifocal/ varifocal/ look-over Type: hard/ soft/ gas permeable/ disposable
49) Color Perception Normal / Abnormal

Pseudo-isochromatic plates Type:
No. of plates: No. of errors:
50) Remarks, if any
I certify that the applicant MEETS / DOES NOT MEET the medical standards prescribed in Medical Requirement, CAAN in
Eye, Visual Acuity and Color Perception for INITIAL/RENEWAL/OTHER for CLASS I / II /III medical certificate.
If not, specify ……………………………………………………………………………………………………………………………………….
Name of Specialist Medical Examiner: …………………………………………….……… Signature: …………………………….
Place of examination: ...................................................... Date: ........................................

5TH EDITION
ATTACHMENT: A-5/6

MEDICAL ASSESSMENT FORM
For use by Civil Aviation Medical Assessor
Part A
Full Name: Sex: Male / Female Date of birth:
Address:
Contact Details Mobile: E–mail:
Licence No. (ATPL/CPL/MPL/PPL/UPL/FE/ATC)……………. Expiry Date:
Airline: Family physician‘s or Airline Doctor‘s Name:
Address (Clinic/Hospital):
Mobile: E–mail:
Total flight hours: Total flight hours since last medical: Last Medical examination: Date/Place
Any aircraft accident or reported incident? Yes / No

If yes, Details, Date & Place:
Any inflight incapacitation? Yes / No

Part B
Aviation medical assessment previously denied, suspended or revoked by any Licensing authority? Yes / No
Medical events or illness any time: Yes / No
Any abnormal findings in ―Application and Statement Form‖ and in ―Medical Examination Forms‖: Yes / No
Limitations/Restriction on Licence/ Medical Assessment previously prescribed? Yes / No

If yes, Details:
Assessment, Remarks, Recommendation:
Any communication to the applicant:
Part C
Limitations:
I RECOMMEND / DO NOT RECOMMEND for INITIAL/RENEWAL/OTHER licence as the applicant
MEETS / DOES NOT MEET the medical standards prescribed in Medical Requirements, CAAN for CLASS I / II / III
Medical Certificate.
………………………………………..
Date: Signature
Civil Aviation Medical Assessor

5TH EDITION
ATTACHMENT: A– 6/6
MEDICAL CERTIFICATE
Name & Address
Licence Number:
Date of Birth Height in cm Weight in Kg Hair color Eyescolor Sex Blood Group
This certifies that the holder has met the medical standards prescribed in Medical Requirements, CAAN
for class …………………. Medical Certificate.
Date of Medical Certification Valid until
Signature of Civil Aviation Medical Assessor Stamp
Signature of Holder
Note: Bring this Certificate on next medical examination.

5TH EDITION
ATTACHMENT: B– 1/2

INSTRUCTION FOR APPLICANTS
This Application and Statement Form, along with all attached Report Forms and papers will be transmitted to the Medical
Assessor of the Licensing Authority. Medical confidentiality will be respected at all times. The Applicant must personally
tick or circle or complete in full all questions (boxes) on the Application and Statement Form. Writing must be in Block
letters with a black ballpoint pen and must be legible. If more space is required to answer any question, attach a plain
sheet of paper and sign with the date.
NOTICE: Failure to complete the Application and Statement Form in full or to write legibly will result the form not being
accepted. Making false or misleading statements or withholding relevant information in respect of this application may
result in criminal prosecution, refusal of this application and/or withdrawal of any Medical Assessment(s) previously
granted.
1. FULL NAME: 2. DATE OF BIRTH:
State name in full. Specify in order: day (DD), month (MM), year (YYYY) in numerals,
Example: 22-08-1960.
3. GENDER: 4. ADDRESS:
Tick appropriate item. State main place of residence, with contact details, telephone
number and e-mail address.
5. NATIONALITY: 6. OCCUPATION:
State name of country of citizenship State occupation.
7. EMPLOYER / AIRLINE: 8. FAMILY PHYSICIAN’S AND/OR AIRLINE DOCTOR”S
State principal employer. NAME AND ADDRESS (if applicable).
Provide contact details of family physician or airline doctor.
9.AVIATOIN LICENCE HELD (TYPE): 10. TOTAL FLIGHT TIME (HOURS):
Write Licence number and country of issue. Provide information For pilots, state total number of hours flown in an operating
concerning Licences already held. capacity. For others, write “Not applicable.
11. LAST MEDICAL EXAMINATION: 12. ANYLIMITATIONSONTHELICENCE/MEDICAL
State date (day/month/year) and place (city/town and country) CERTIFICATE:
of last aviation medical examination. Provide details of any limitations on your Licence(s) and/or medical
certificate(s), e.g. correcting lenses, valid daytime only, multi-pilot
operations only
13. HAVE YOU EVER HAD AN AVIATION MEDICAL ASSESSMENT 14. ANY AIRCRAFT ACCIDENT OR REPORTED INCIDENT:
DENIED, SUSUPENDED OR REVOKED BY ANY LICENSING If “Yes” provide details. If already given in earlier statement, state
AUTHORITY? so.
Tick “Yes” if you have ever had a Medical Assessment denied,
suspended or revoked, even if temporarily. Provide the date, place and
details, and discuss with the medical examiner.
15. AIRCRAFT CURRENTLY FLOWN: 16. TYPE OF APPLICATION:
State the name of aircraft currently flown e.g. Piston engine, Turbo Tick appropriate item. Tick “initial” if this is your first application to
prop, Jet etc. this Licensing authority, even if you hold other similar Licence
issued by another Licensing authority. Mention validation of foreign
licence, if applicable
17. CLASS OF MEDICAL ASSESSMENT APPLIED FOR: 18.TYPE OF FLYING INTENDED :
Tick appropriate item. Provide details of intended flying e.g. Single crew or Multi crew;
Commercial, Instructor, Private. Write NA if not applicable.
19. DO YOU SMOKE TOBACCO PRODUCTS?
Tick applicable box. Current smokers should state type and amount e.g. 20 cigarettes per day; pipe, 30 grams weekly.
20. DO YOU DRINK ALCOHOLIC BEVERAGES?
State average weekly intake in units Example: 10 units/wk, 20 units/wk (spirits, beer, wine).
Note: 1 unit = 10 g of alcohol.
1 unit corresponds to 30 ml of spirits, 100 ml of wine and 300 ml of beer. Spirits include whisky, brandy, gin, rum, vodka.
21. DO YOU CURRENTLY USE ANY MEDICATION INCLUDING NON- PRESCRIBEDMEDICATION OR PSYCHOCATIVE SUBSTANCES? State
medications prescribed by a medical practitioner and also non-prescribed medication e.g. herbal remedies, medications bought without prescription.
If “Yes” is ticked, provide details: name of medication, date treatment was commenced, daily/weekly dose and the condition or problem for which the
medication is taken. Psychoactive substances include opioids, cannabinoids, cocaine, sedatives, hypnotics, hallucinogens, psycho stimulants etc.
22. GENERAL AND MEDICAL HISTORY:
All items from 101 to 132 and 135 to 144 must have answers “Yes” or “No” ticked in appropriate boxes. Items 133 and 134 to be ticked by females
only. Do not tick “Yes” to occasional self-limiting, mild illnesses like common cold, aches, pains etc.
All the questions asked are medically important, even though this may not be readily apparent. Items 135 to 144 relate to history of immediate family
members.
23. REMARKS:
For yes on any of the items in 22, kindly elaborate.
If the information has been reported in a previous Application and Statement Form to the Licensing authority issuing the Medical Assessment applied
for and there has been no change in your condition, you may state “Previously reported, Unchanged”. However you must tick “Yes” for that condition.
24. DECLARATION AND CONSENT TO RELEASE OFMEDICAL INFORMATION:
Do not sign or date this section until indicated to do so by the Designated Medical Examiner who will act as witness and sign also.
AN APPLICANT HAS THE RIGHT TO REFUSE ANY EXAMINATION AND TEST AND TO REQUEST REFERRAL TO
THEAUTHORITY.HOWEVER, THIS MAY ENTAIL TEMPORARY DENIALOF MEDICAL CERTIFICATION.
Rev. 00 CIVIL AVIATION AUTHORITY OF NEPAL Page – ATTCH-C- 1

5TH EDITION
ATTACHMENT: B– 2/2

INSTRUCTION FOR DESIGNATED MEDICAL EXAMINER/SPECIALISTMEDICAL
EXAMINER
ON HOW TO COMPLETETHEMEDICAL EXAMINATION FORM
All questions (boxes) on the Medical Examination Form must be completed in full.
Writing must be in BLOCK LETTERS with a black ballpoint pen and must be legible. Exert sufficient pressure to make legible
copies. If more space is required to answer any question, attach a plain sheet of paper with the applicant‘s name and birth date, the
additional information required, followed by your signature and the date. The following instructions apply to the same numbered
headings on the Medical Examination Form.
NOTICE: Failure to complete the Medical Examination Form in full as required or to write legibly may result in rejection of the
application in total and may lead to withdrawal of any Medical Assessment issued. Making false or misleading statements or
withholding relevant information by Designated Medical Examiner/ Specialist Medical Examiner may result in disciplinary action
including criminal prosecution.
1. NAME: State name in full.

2. DATE OF BIRTH: Specify in order: day(DD), month(MM),year(YYYY) in numerals, Example: 22-08-1960.
3. SEX: Tick or circle appropriate item.
4. TYPE OF APPLICATION: Tick or circle appropriate item.
Initial: Initial examination for Medical Assessment Class I, II or III.
Renewal: Subsequent routine examinations.
Other: Examinations other than initial or subsequent renewal examinations.
5. CLASS OF MEDICAL ASSESSMENT APPLIED FOR: Tick or circle appropriate item.
6. TYPE OF FLYING INTENDED: Provide details of intended flying e.g. Single crew or Multi crew; Commercial, Instructor,
Private. Write NA if not applicable.
7. HEIGHT in cm/ WEIGHT in kg: Measure height without shoes in centimetres. Measure weight in light dress in kilograms
2
8. BMI: Calculate BMI using formula weight in kg divided by (height in meter)
9. EYE COLOR: State color of applicant‘s eyes from the following list: brown, blue, green, hazel, grey, multi.
10. HAIR COLOR: State color of applicant‘s hair from the following list: brown, black, blonde, auburn, red ,grey, white.
11. BLOOD PRESSURE: Blood Pressure readings should be recorded as Phase I for Systolic pressure and Phase V for Diastolic
pressure. The applicant should be seated. Record blood pressure in mm Hg. You may be required to check BP after a few
minutes of rest if found high in the first reading.
12. PULSE (RESTING): The pulse rate should be recorded in beats per minute and the rhythm should be recorded as regular or
irregular.
SECTIONS 13 to 30inclusive constitute the general clinical examination and each of the sections must be checked as
Normal or Abnormal.
13. HEAD, FACE, NECK, SCALP: To include appearance, range of neck movements, symmetry of facial movements, etc.
14. MOUTH, THROAT, TEETH: To include appearance of buccal cavity, soft palate motility, tonsillar area, pharynx as well as
gums, teeth and tongue.
15. NOSE, SINUSES: To include appearance and any evidence of nasal obstruction or sinus tenderness on palpation.
16. EARS: To include otoscopy of external ear, ear canal, and tympanic membrane. Eardrum motility assessed by valsalva
maneuver or by pneumatic otoscopy. If wax is obstructing the view, clean it first.
17. EYES: General examination of both eyes, do visual fields examination by confrontation.To include appearance, size,
reflexes, light reflex and fundoscopy. Look for presence of any corneal scars. To include range of movement of eyes in all
directions; symmetry of movement of both eyes; ocular muscle balance; convergence; accommodation; nystagmus.
18. LUNGS, CHEST and BREASTS: To include inspection of chest for deformities, operation scars, abnormality of respiratory
movement, auscultation of breath sounds. Physical examination of the female applicant‘s breasts is optional. If not
examined, state so.

5TH EDITION
19. HEART: To include apical heartbeat, position, auscultation for murmurs, carotid bruits, palpation for thrills.
20. VASCULAR SYSTEM: To include examination for varicose veins, character and feel of pulse, peripheral pulses, evidence
of peripheral vascular disease.
21. ABDOMEN, HERNIA, LIVER, SPLEEN: To include inspection of abdomen; palpation of internal organs; particularly
check for inguinal hernias.
22. ANUS, RECTUM: Clinical examination is done if applicable and indicated by history. If not examined, state so.
23. GENITO-URINARY SYSTEM: Clinical examination is done if applicable and indicated by history. If not examined, state
so.
24. ENDOCRINE SYSTEM: To include inspection, palpation for evidence of hormonal abnormalities/imbalance; thyroid gland.
25. UPPER AND LOWER LIMBS, JOINTS: To include full range of movements of joints and limbs, any deformities,
weakness or loss. Look for evidence of arthritis.
26. SPINE, OTHER MUSCULOSKELETAL: To include range of movements, deformity, abnormalities of joints.
27. NEUROLOGIC – REFLEXES ETC: To include reflexes, sensation, power, vestibular system– balance, Romberg test.
28. PSYCHIATRIC: To include evaluation of appearance, mood/thought, behaviour (see also 56-57).
29. SKIN and LYMPHATICSYSTEM: To include inspection of skin; inspection and palpation for lymphadenopathyetc.
30. GENERAL SYSTEM: All other areas and systems, including nutritional status.
31. ANY OTHER RELEVANT OBSERVATION OR FINDINGS: Write down any other relevant observation or findings seen
during examination.
32. IDENTIFYING MARKS, TATTOOS, SCARS, ETC: List items that may be used for physical identification.
33. NOTES: Any notes, comments or abnormalities to be described – add extra notes if required on separate sheet of paper,
write name, date of birth of applicant; then sign and date.
34. EAR, NOSE, THROAT AND HEARING: Write the name of Specialist Medical Examiner from ENT group who examined
the applicant along with date examined.
35. EYE, VISUAL ACUITY AND COLOR PERCEPTION: Write the name of Specialist Medical Examiner from EYE,
VISUAL ACUITY AND COLOR PERCEPTION group who examined the applicant along with date examined.
36. ANY OTHER RELEVANT OBSERVATION OR FINDINGS RELATED TO ENT EXAMINATION: Write any other
relevant findings related to ENT examination.
37. HEARING: Tick appropriate box to indicate hearing ability as tested separately in each ear in whispering voice at 1m and
conversation voice at 2m.The applicant should not be able to observe the examiner‘s lips.
38. AUDIOMETRY: If pure-tone audiometry is required, the frequencies from 125 to 8000 Hz should be measured and the
audiometric results recorded in an audiogram. The full range of frequencies has diagnostic value and is useful for provision
of advice concerning hearing conservation.
39. REMARKS, IF ANY: Write down any other remarks if it is relevant.
40. EYES – ORBIT AND ADNEXA, VISUAL FIELDS: General examination of both eyes, do visual fields examination by
confrontation.
41. EYES – PUPILS AND OPTIC FUNDI: To include appearance, size, reflexes, light reflex and fundoscopy. Look for
presence of any corneal scars.
42. EYES – OCULAR MOTILITY, NYSTAGMUS: To include range of movement of eyes in all directions; symmetry of
movement of both eyes; ocular muscle balance; convergence; accommodation; nystagmus.
43. ANY OTHER RELEVANT OBSERVATION OR FINDINGS RELATED TO EYE EXAMINATION: Write any other
relevant findings related to EYE examination.
44. DISTANT VISION AT 6 METRES: Each eye to be examined separately, then both together. First without correction, then
with spectacles (if used) and lastly with contact lenses, if used. Record visual acuity in appropriate boxes. Use Snellen‘s
chart or any other standard chart.
45. INTERMEDIATE VISION AT 1 METRE: Each eye to be examined separately and then both together. First without
correction, then with spectacles if used and lastly with contact lenses if used. Record visual acuity in appropriate boxes as
ability to read N14 at 100 cm.
46. NEAR VISION AT 30–50 CM: Each eye to be examined separately and then both together. First without correction, then
with spectacles if used and lastly with contact lenses, if used. Record visual acuity in appropriate boxes as ability to read N5
at 30–50 cm.Note: Bifocal contact lenses and contact lenses correcting for near vision only are not acceptable.
47. SPECTACLES: Tick appropriate box signifying if spectacles are or are not worn by applicant. If used, state whether
unifocal, bifocal, varifocal or ―look-over‖.
48. CONTACT LENSES: Tick appropriate box signifying if contact lenses are or are not worn. If worn, state type from the
following list; hard, soft, gas-permeable or disposable.

5TH EDITION
49. COLOR PERCEPTION: If required, tick appropriate box signifying if color perception is normal or not. State which test is
used e.g. Ishihara 24 plate. If abnormal, state number of plates read incorrectly.
50. REMARKS, IF ANY: Write down any other remarks if it is relevant.
51. to 55. ACCOMPANYING REPORTS: One box opposite each of these sections must be ticked. If the test is not required and
has not been performed, then tick the NOT PERFORMED box. If the test has been performed (whether required or on
indication) complete the normal or abnormal box, as appropriate. In Other, write the name of any accompanying reports
done like chest X-ray, exercise ECG, ECHO, lipid profile, blood sugar, or any other additional test.
56. MENTAL HEALTH ASPECTS OF FITNESS DISCUSSED: Applicants should be asked about their mental health and if
they have any concerns about this aspect of their medical fitness. Mental health aspects refer to conditions such as
depression and anxiety. Questions based on those that have been validated in primary health care settings should be used
where possible, e.g. concerning depression. Fatigue-related issues can also be addressed in this part of the examination.
Medical examiners should be conversant with the causes, prevention and treatment of fatigue, especially those related to
sleep apnea and/or which require medication to be alleviated. It is not required that the contents of such discussions are
recorded unless they impact on the Medical Assessment (see Manual of Civil Aviation Medicine for guidelines).
57. BEHAVIORAL ASPECTS OF FITNESS DISCUSSED: Applicants should be asked about behavioural aspects related to
their health and if they have any concerns about this aspect of their medical fitness. Behavioural aspects refer to such
behaviours ,e.g. as problematic use of substances.
58. PHYSICAL ASPECTS OF FITNESS DISCUSSED: Applicants should be asked about physical aspects of their health and if
they have any concerns about this aspect of their medical fitness. Questions concerning physical exercise, weight, diet,
smoking, etc., can be covered in this portion of the medical examination.. Examiners should be aware of standard preventive
guidelines concerning common physical diseases and provide such advice as appropriate. Since gastrointestinal upset is a
common cause of in-flight incapacitation, advice concerning healthy eating habits, especially when abroad, may usefully be
given in this section. It is not required that the contents of such discussions are recorded unless they impact on the Medical
Assessment (see Manual of Civil Aviation Medicine for guidelines).
59. PREVENTIVE HEALTH ADVICE GIVEN: The goal of items56-58is to address adverse aspects of mental, behavioural
and physical health that are amenable to prevention. State whether preventive advice has been given by ticking Yes or No.
60. COMMENTS, RESTRICTIONS, LIMITATIONS, ETC: Enter here your findings and assessment of any abnormality in the
history or examination. State also any limitation required.
61. CIVIL AVIATION MEDICAL EXAMINER‘S RECOMMENDATION: Tick or circle as appropriate. FIT/UNFIT;
INITIAL/RENEWAL/OTHERS; CLASS I /II / III. If recommendation is not made, the reason must be stated.
62. CLINIC ADDRESS AND DATE: Enter the address of clinic where applicant was examined and the date of examination.
The date of examination is the date of the general examination and completion of all required tests.
63. DESIGNATED MEDICAL EXAMINER‘S NAME, TEL NUMBER, E MAIL, FAX(if available): Write your name, contact
telephone number and e-mail address (and fax if available) or put in stamp stating all details.
64. DESIGNATED MEDICAL EXAMINER‘S SIGNATURE: Sign in this box.
----------------------------END--------------------------

5TH EDITION
ATTACHMENT: C– 1/3
CLINIC/HOSPITAL INSPECTION CHECKLIST
DESIGNATED MEDICAL EXAMINER
Name of Applicant DME: _____________________ Address (Clinic / Hospital):__________________
Contact Number: ____________________________ Email: __________________________________
1. Equipment Present Not Present Remarks

Stethoscope
BP Instrument Taken by
Doctor/Technician/Nurse
Weighing Machine
Height scale
Knee hammer
Torch
ECG machine
X-ray view box
Urine strip test
2. Physical Facility Present Not Present

Examination Room
Waiting Room
Parking Area
Driveway/Approach
3. Other Facilities Present/Adequate Not Present/Inadequate

Telephone
Lighting
Heating
Cleanliness
Noise management
4. Staff Present Not Present

Nurse
Physician Assistant
Technician
Receptionist
5. Clinic
Type Hospital/Nursing Home/Polyclinic/Private
Preferred Days
Preferred Time
6. Comments if any:
Recommendations : Approved /Not approved
______________________ ________________ _______________________

Signature of Applicant DME Signature of CAMA Signature of Inspector, FSSD
Date: __________________

5TH EDITION
ATTACHMENT: C-2/3
SPECIALIST MEDICAL EXAMINER CLINIC/HOSPITAL INSPECTION CHECKLIST
SPECIALIST MEDICAL EXAMINER: EYE
Name of Applicant SME: ____________________________ Address (Clinic / Hospital): __________________
Contact Number: _________________________________ Email: __________________________________

Distant Vision Chart
Near Vision Chart
Color Vision Plates
Ophthalmoscope
Slit Lamp
Torch

Examination Room
Waiting Room
Parking Area
Driveway/Approach

Telephone
Lighting
Heating
Cleanliness
Noise management

Nurse
Physician Assistant
Technician
Receptionist
5. Clinic
Preferred Days
Preferred Time
6. Comments if any:
Recommendations : Approved / Not approved
_______________________ ________________ _______________________

Signature of Applicant SME Signature of CAMA Signature of Inspector, FSSD
Date: _____________________

5TH EDITION
ATTACHMENT: C-3/3
SPECIALIST MEDICAL EXAMINER CLINIC/HOSPITAL INSPECTION
CHECKLIST SPECIALIST MEDICAL EXAMINER: ENT
Name of Applicant SME: ___________________________ Address (Clinic / Hospital): ______________________
Contact Number: __________________________________ Email: _______________________________________

Otoscope
Tuning Fork
Headset: mirror/lamp
Audiometry
Torch

Examination Room
Waiting Room
Parking Area
Driveway/Approach

Telephone
Lighting
Heating
Cleanliness
Noise management

Nurse
Physician Assistant
Technician
Receptionist
5. Clinic
Preferred Days
Preferred Time
6. Comments if any:
Recommendations : Approved /Not approved
_______________________ ________________ _______________________

Signature of Applicant SME Signature of CAMA Signature of Inspector, FSSD
Date: ____________________________

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CIVIL AVIATION AUTHORITY OF NEPAL

FIFTH EDITION 2020

First Edition 2002

This manual is available at:

Rev. 00 CIVIL AVIATION AUTHORITY OF NEPAL

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Number Date Entered by

01 April 01, 2021 Januka Khanal

02 March 17, 2023 Januka Khanal

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LIST OF EFFECTIVE PAGES

CHAPTER PAGE REVISION NUMBER DATE

CH-1 1-12 01 April 01, 2021

CH-1 1-10, 1-11 02 March 17, 2023

CH-2 2-27 02 March 17, 2023

CH-3 3-15, 3-16 02 March 17, 2023

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Rev. 00 CIVIL AVIATION AUTHORITY OF NEPAL

Medical Requirements consists of 4 parts:

Part 0 : Document Control

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PART 0 DOCUMENT CONTROL 0-1 to 0-4

PART 1 GENERAL REQUIREMENT FOR MEDICAL

1.1 REQUIREMENT OF MEDICAL ASSESSMENT 1-2

1.2 MEDICAL FORMS 1-2

1.3 MEDICAL HISTORY DECLARATION 1-2

1.4 MEDICAL EXAMINATION 1-3

1.5 MEDICAL ASSESSMENT 1-5

1.6 MEDICAL CONFIDENTIALITY 1-6

1.7 MEDICAL FITNESS 1-6

1.8 DECREASE IN MEDICAL FITNESS 1-6

1.9 BORDERLINE MEDICAL FINDING 1-7

1.10 ACCREDITED MEDICAL OPINION 1-7

1.11 MEDICAL FLIGHT TEST 1-7

1.12 FLEXIBILITY CLAUSE 1-7

1.13 MEDICALLY UNFIT OR DEFERRED MEDICAL

1.14 SUSPENSION OF LICENCE ON MEDICAL GROUNDS 1-8

1.15 PROVISION OF APPEAL 1-8

1.16 EXPIRED LICENCE DUE TO MEDICAL REASON 1-8

1.17 VALIDATION OF FOREIGN LICENCE 1-9

1.18 DISPENSATION OF MEDICAL EXAMINATION AND

1.19 EXCEEDING CUMULATIVE FLIGHT HOURS LIMITATION 1-9

1.20 FEE 1-9

1.21 DESIGNATED MEDICAL EXAMINER 1-9

1.22 SPECIALIST MEDICAL EXAMINER 1-11

1.23 CIVIL AVIATION MEDICAL ASSESSOR 1-12

1.24 MEDICAL ASSESSMENT CLASSES 1-13

1.25 VALIDITY PERIOD OF MEDICAL ASSESSMENT 1-14